Site Infection In General Surgery Research Articles

Challenges and strategies in the prevention and management of surgical site infections in general surgery: a comprehensive review

The present study addresses strategies for the prevention and management of surgical site infections (SSI) in general surgery. The importance of preoperative antibiotic prophylaxis, the preparation of the patient's skin, and the meticulous surgical technique in reducing the incidence of SSI are highlighted. During surgery, maintaining a sterile environment and minimizing tissue manipulation are crucial. After surgery, post-operative care, such as wound monitoring and patient education, is essential. SSIs negatively impact patient recovery and increase hospital costs. Implementing evidence-based practices is critical to improving patient safety and reducing costs associated with SSIs.

Tailored Pre-Operative Antibiotic Prophylaxis to Prevent Post-Operative Surgical Site Infections in General Surgery.

The average American today undergoes three inpatient and two outpatient surgical procedures during one's life, each of which carries with it a risk of post-operative infection. It has long been known that post-operative infections cause significant morbidity in the immediate peri-operative period, but recent evidence suggests that they can have long-term consequences as well, increasing a patient's risk of infectious complications in unrelated surgeries performed months or even years later. While there are several theories on the origin of this association, including bacterial colonization of a post-operative infectious wound site, antimicrobial resistance from curative courses of antibiotics, subclinical immunosuppression, or the creation of an inflammatory "pathobiome" following an infectious insult, it is ultimately still unclear why patients who experience a single post-operative infection seem to be at a significantly higher risk of experiencing subsequent ones. Regardless, this association has significant implications for the routine use of pre-operative antibiotic prophylaxis. Indeed, while the prescription of antibiotics pre-operatively has dramatically reduced the rate of post-operative infections, the chosen prophylaxis regimens are typically standardized according to national guidelines, are facing increasing antimicrobial resistance patterns, and have been unable to reduce the risk of post-operative infection to acceptably low levels for certain surgeries. As a result, some clinicians have speculated that tailoring pre-operative antibiotic prophylaxis according to a patient's prior infectious and operative history could improve efficacy and further reduce the rate of post-operative infections. The purpose of this review is to describe the evidence for the link between multiple post-operative infections and explore the efficacy of individualized pre-operative prophylaxis.

Antibiotic Prophylaxis for Surgical Site Infection in General Surgery: Oncological Treatments and HIPEC.

The procedure of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a combined surgical and oncological treatment for peritoneal carcinomatosis of various origins. Antibiotic prophylaxis is usually center-related and should be discussed together with the infectious disease specialist, taking into account the advanced oncologic condition of the patient, the complexity of surgery—often requiring multiorgan resections—and the risk of post-HIPEC neutropenia. The incidence of surgical site infection (SSI) after CRS and HIPEC ranges between 11 and 46%. These patients are also at high risk of postoperative abdominal infections and septic complications, and a bacterial translocation during HIPEC has been hypothesized. Many authors have proposed aggressive screening protocols and a high intra and postoperative alert, in order to minimize and promptly identify all possible infectious complications following CRS and HIPEC.

Surgical Site Infections in General Surgery at the Regional Hospital of Thies (Senegal): Epidemiological, Bacteriological Aspects and Risk Factors

Introduction: Surgical Site Infections (SSIs) are frequent and lead to serious consequences and in terms of morbidity and mortality, with an increase in the length of hospitalization and health costs. Developing countries are the most affected. The aim of our study was to describe the epidemiological, clinical, and bacteriological aspects of SSIs in general surgery at the RH of Thies. Methods: This is a prospective study over a period of seven months (7 months) from September 1, 2018 to March 31, 2019 at the level of the general surgery department of the Regional Hospital of Thies. Bacteriological studies were carried out at the level of the Bacteriology unit of the National Public Health Laboratory of Senegal. Results: The incidence of SSIs in our study was 9.9%. The SSIs rate was 15.3% among resident surgeons, 10% among junior surgeons, 6.8% among senior ones. The surgical intervention was classified as Altemeier stage 1 in 3.4% of cases (n = 1), stage 2 in 27.6% of cases (n = 8), stage 3 in 24.1% of cases (n = 7) and stage 4 in 44.8% of cases (n = 13). Twenty-two of the isolated stems (73.3% of cases) were multidrug-resistant bacilli. The extended spectrum beta lactamase (ESBL) phenotype was found in 22 isolates and 1 stem of K. pneumoniae was resistant to all antibiotics. Conclusion: SSIs constitute a challenge because of their high frequency and the high resistance of germs to common antibiotics. Currently, the main mode of resistance of bacteria in SSIs is the secretion of ESBL. This phenomenon seems to be major in our regions where it is urgent to review the therapeutic protocols in practice in the services.

An economic model to assess the value of triclosan-coated sutures in reducing the risk of surgical site infection in general surgery in India

Surgical site infections (SSIs) are increasing worldwide. The present study demonstrates the efficacy and economic outcome of triclosan-coated sutures (TCS) vs conventional non-antimicrobial-coated sutures (NCS) for SSIs in general surgery in India. A systematic literature search of available evidence for both SSI incidences and TCS efficacy data in India from 1998-2018 and 2000-2018, respectively, were gathered. We collected cost data from a private and public hospital, respectively for hernia and cholecystectomy procedures. The cost-effectiveness of TCS in comparison to the conventional NCS was calculated using a decision-tree deterministic model. We performed a one-way sensitivity analysis to compare TCS vs NCS. We found a base cost saving of INR 9621 (private hospital) and INR 1900 (public hospital). Whereas, for cholecystectomy, it was INR 14450 (private hospital) and INR 2643 (public hospital). The use of TCS resulted in reduced SSI incidence and cost savings for general surgeries in India.

Prevalence of surgical site infections in general surgery in a tertiary care centre in Eastern India

Prevalence of surgical site infections in general surgery in a tertiary care centre in Eastern India

Prevalence of surgical site infection in general surgery in a tertiary care centre in India

Background: Surgical site infection (SSI) can be defined as an infection that is present up to 30 days after a surgical procedure if no implants are placed and up to one year if an implantable device was placed in the patient. SSI is a significant problem associated with major surgeries and is the 3rd most frequently reported nosocomial infection. This study aims to study the prevalence of SSI in the Department of Surgery, Rajendra Institute of Medical Sciences (RIMS), Ranchi.Methods: A retrospective study was undertaken at the Department of General Surgery for a period of one year. Retrospective chart review was conducted from the hospital database. The rate of SSI was studied in relation to its type, the type of surgical procedure and elective vs emergency surgeries.Results: The present study revealed 12.5% prevalence of SSI in Department of General Surgery, RIMS. Among the 3 types, superficial incision SSI was most prevalent followed by deep incisional SSI and finally by organ/space SSI. The surgical procedure most commonly associated with SSI was exploratory laparotomy. An alarming 17.7% of SSI was associated with emergency surgeries as compared to 12.5% of elective surgeries.Conclusions: The consequences of SSIs greatly impact patients and the healthcare systems. Prevention of SSI requires a multifaceted approach targeting pre-, intra-, and postoperative factors. It is imperative that facilities have open-minded management teams, regulatory agencies and medical associations that want to provide the foundation required to generate a culture of patient safety in our health care systems.

Surgical Site Infection in General Surgery

Surgical Site Infection in General Surgery

What really affects surgical site infection rates in general surgery in a developing country?

To assess the risk factors for surgical site infection and the effects of selected infection control measures on surgical site infection rates in a general surgery unit. Surgical site infection rates and adherence to infection control measures were observed in a general surgery unit. In multivariate analysis, male gender, a high American Society of Anesthesiologists (ASA) score, malignancy, transfusion, open surgery, and contaminated and dirty operations were found to be statistically significant risk factors for surgical site infection. Among infection control measures, only the avoidance of preoperative hair removal and a longer AMP duration had protective effects on SSI. The most important risk factor influencing surgical site infection in general surgery was found to be the contamination level of the wound.

Incidence and risk factors of surgical site infection in general surgery in a developing country

To investigate the incidence of surgical site infections (SSIs) according to risk factors, etiological agents, antimicrobial resistance rates of pathogens, and antimicrobial prophylaxis (AMP) in a developing country. Prospective surveillance of SSIs was carried out in general surgery (GS) units between May 2005 and April 2009. SSI was diagnosed in 415 (10.8%) patients. Cefazolin was used as AMP in 780 (49%) operations, whereas broad-spectrum antibiotics were used in the remaining operations. AMP was administered for >24 h in 69 and 64% of the GS patients. The most significant risk factors for SSI after GS were total parenteral nutrition, transfusion, and a drainage catheter. The most common pathogen was Escherichia coli, but all the isolated pathogens were multiresistant. AMP is effective for reducing the risk of SSI; however, the prolonged use of AMP and broad-spectrum antibiotics may be associated with the emergence of resistant bacterial strains.

Predictive factors for surgical site infection in general surgery

Global parameters, such as wound class, the American Society of Anesthesiologists' physical classification score, and prolonged operative time, have been associated with the risk of surgical site infection (SSI). We hypothesized that additional risk factors for SSI would be identified by controlling for these parameters and that deep and organ/space SSI may have different risk factors for occurrence. A retrospective review was performed on general and vascular surgical patients who underwent an operation between June 2000 and June 2006 at a single institution. Patients with SSI were matched with a case-control cohort of patients without infection (no SSI) according to age, sex, ASA score, wound class, and type of operative procedure. Data were analyzed using bivariate and regression analyses. Overall, 10,253 general surgical procedures were performed during the 6-year period; 316 patients (3.1%) developed SSI. In all, 300 patients with 251 superficial (83.6%), 22 deep (7.3%), and 27 organ/space (9%) SSIs were matched for comparison. Multivariate logistic regression analysis identified previous operation (odds ratio [OR], 2.4; 95% confidence interval [CI] = 1.6-3.7), duration of operation >or=75th percentile (OR, 1.8; 95% CI = 1.2-2.8), hypoalbuminemia (OR, 1.8; 95% CI = 1.1-2.8), and a history of chronic obstructive pulmonary disease (OR, 1.7; 95% CI = 1.0-2.8) as independent risk factors for SSI. Only hypoalbuminemia (OR, 2.9; 95% CI = 1.4-6.3) and a previous operation (OR, 2.0; 95% CI = 1.0-4.4) were significantly associated with deep or organ/space infections. These results demonstrate additional factors that increase the risk of developing SSI. Deep and organ/space infections have a different risk profile. This information should guide clinicians in their assessment of SSI risk and should identify targets for intervention to decrease the incidence of SSI.

Incidence of Surgical Site Infections in General Surgery in Italy

Epidemiological study to determine surgical site infection (SSI) rates in surgical patients in Italy using the National Nosocomial Infections Surveillance system (NNIS), to monitor current surgical antimicrobial prophylaxis, and to identify possible modifiable risk factors for SSI. Thirty-two general surgeries participated in the study. Main criteria for site inclusion were: > 20 operations per week and amoxycillin/clavulanate among prophylactic options. Each patient operated from April 1st to May 30th 2002 was surveyed until 30 days after the operation. SSI cumulative incidence rates and 95% confidence intervals (95%CI) were calculated. During the study period, 3,066 surgical procedures were performed in 2,972 patients. A total of 158 SSI were diagnosed in 154 patients: 96 (62.3%) were at superficial incision, 23 (14.9%) were at deep incision and 35 (22.7%) were at organ-space site. Incidence of SSI every 100 operations was 5.2% (95% CI 4.4-6.0). Of the 2,437 operated patients with clean or elective clean/contaminated or contaminated surgical procedure, 2,105 (86.4%) received antimicrobial prophylaxis, mainly amoxicillin/clavulanate (28.3%) and ceftizoxime (11.4%). Pre-operative hospital stay > or = 48 h, diabetes, obesity, and HIV/AIDS infection were statistically significantly associated with increased risk of SSI. The SSI rates found are comparable with European studies and can be a benchmark for national incidence data and for inter- and intra-hospital SSI rate comparisons.