Abstract
Surgical site infections represent a considerable burden for healthcare systems. To obtain a consensus on the impact and future clinical and economic needs regarding SSI management in an era of multidrug resistance. A modified Delphi method was used to obtain consensus among experts from five European countries. The Delphi questionnaire was assembled by a steering committee, verified by a panel of experts and administered to 90 experts in 8 different surgical specialities (Abdominal, Cancer, Cardiac, General surgery, Orthopaedic, Thoracic, Transplant and Vascular and three other specialities (infectious disease, internal medicine microbiology). Respondents (n = 52) reached consensus on 62/73 items including that resistant pathogens are an increasing matter of concern and increase both treatment complexity and the length of hospital stay. There was strong positive consensus on the cost-effectiveness of early discharge (ED) programs, improvement of quality of life with ED and association between increased length of stay and economic burden to the hospital. However, established ED protocols were not widely available in their hospitals. Respondents expressed a positive consensus on the usefulness of antibiotics that allow ED. Surgeons are aware of their responsibility in an interdisciplinary team for the treatment of SSI, and of the impact of multidrug-resistant bacteria in the context of SSI. Reducing the length of hospital stays by applying ED protocols and implementing new treatment alternatives is crucial to reduce harm to patients and costs for the hospital.
Highlights
MethodsDespite proper precautions, surgical site infections (SSI) remain a major challenge, comprised 18.4% of all acute care-associated infections, an incidence similar to that of hospital-acquired pneumonia or urinary tract infections [1], and result in an estimated 16,049 deaths per year [2]
For the purpose of this consensus, we have considered superficial and deep incisional infections occurring after an index surgery (Appendix 2—Supplemental File 2), according to the US Centers for Disease Control and Prevention (US CDC) definition [21, 22]
Statement 1.3: Antimicrobial resistance in SSI Respondents strongly agree that resistant pathogens are an increasing matter of concern in SSIs, that they increase both treatment complexity, and LOS
Summary
Surgical site infections (SSI) remain a major challenge, comprised 18.4% of all acute care-associated infections, an incidence similar to that of hospital-acquired pneumonia or urinary tract infections [1], and result in an estimated 16,049 deaths per year [2]. Causative pathogens are usually commensal bacteria associated with the surgical site [8], and tend to vary according to the procedure [9]. Whereas Gram-positive microorganisms like S. aureus are the most common causative pathogens, Gram-negative bacteria including Enterobacteriaceae may cause SSIs, especially after abdominal procedures. Another element of variability is the risk of infection with antimicrobial-resistant (AMR) bacteria. SSIs involving AMR pathogens are associated with significant increases in the length of hospitalization and costs [12]
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