Abstract
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.
Highlights
Elective colon surgery continues to have the highest rate of infection at the surgical site among all elective surgical procedures
Unusual gram negative bacteria can be anticipated if the patient has had prior antibiotic exposure or prior exposure to the healthcare environment which has resulted in alteration of their normal microflora
This study identified a 24% Surgical site infection (SSI) rate in those patients inspiring 30% oxygen during and immediately following the colectomy compared to 15% in the 80% supplemental oxygen group (P < 0.04)
Summary
Elective colon surgery continues to have the highest rate of infection at the surgical site among all elective surgical procedures These infections span a continuum of mild superficial infection to those that are deep-seated within the abdominal cavity and pose a serious threat to the patient’s survival. Many have strong scientific foundation, while others are driven solely by expert opinion This presentation will attempt to provide a comprehensive context of the pathogenesis of SSI following elective colon surgery and to define those methods that have evidence to support use for prevention. Superficial infections involve the skin and subcutaneous tissues, deep infections involve the muscle and investing fascia, and organ/space infections are in the abdominal cavity following elective colon surgery These categorical distinctions will be important as the following discussion addresses pathogenesis and prevention
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