Risk Factors and Outcome Analysis of Surgical Site Infections in Chinese Elderly Patients with Intestinal Obstruction After Emergency Surgery

Abstract

Surgical site infection (SSI) and antimicrobial resistance may adversely affect the clinical outcome of older patients. The objective of the study was to investigate the etiology and outcome of SSIs in elderly patients who underwent emergency bowel surgery. We conducted a retrospective study of all patients aged ≥ 60 years who underwent emergency surgery due to an intestinal obstruction from January 2014 to June 2019 in a tertiary teaching hospital in Western China. Demographic data, comorbidities, perioperative physiological and microbiological data, and information on the surgical technique and duration of hospitalization were extracted from clinical records to assess risk factors for SSIs. Of 125 patients included, 115/125 (92%) had a duration of > 48 h postoperative prophylactic antibiotic use; 37 (29.6%) patients were diagnosed with SSI. All occurred within the period of postoperative antimicrobial prophylaxis or after an extended duration of > 48 h prophylactic antibiotic use. Enterobacteriaceae and Enterococcus were the most frequently isolated species (67.4% and 20.9%, respectively): 93.8% of Escherichia coli (15/16) and 33.3% of other Enterobacteriaceae (4/12) isolated were ceftriaxone-resistant. Incision site classification was an independent risk factor for SSI in multivariate analysis. SSI patients had a significantly longer length of stay than those without (29.81 ± 12.96 days vs. 22.52 ± 10.67 days, respectively; p = 0.001). Higher rates of extended-spectrum beta-lactamase-producing Enterobacteriaceae carriage were associated with higher SSI, despite prolonged antimicrobial prophylaxis. This calls for the improved surveillance of resistance in order to offer an alternative prophylaxis for the prevention of these types of infections.