×
Home Current Archive Editorial board
News Contact
Review paper

Risk of surgical site infections after colorectal surgery and the most frequent pathogens isolated: a prospective single-centre observational study

By
George Panos ,
George Panos

Department of Internal Medicine and Infectious Diseases, University General Hospital, Patras, Greece

Francesk Mulita Orcid logo ,
Francesk Mulita
Contact Francesk Mulita

Department of Surgery, General University Hospital, Patras, Greece

Karolina Akinosoglou ,
Karolina Akinosoglou

Department of Internal Medicine and Infectious Diseases, University General Hospital, Patras, Greece

Elias Liolis ,
Elias Liolis

Department of Internal Medicine, Division of Oncology, University General Hospital, Patras, Greece

Charalampos Kaplanis ,
Charalampos Kaplanis

Department of General Surgery, University General Hospital, Patras, Greece

Levan Tchabashvili ,
Levan Tchabashvili

Department of General Surgery, University General Hospital, Patras, Greece

Michail Vailas ,
Michail Vailas

Department of General Surgery, University General Hospital, Patras, Greece

Ioannis Maroulis
Ioannis Maroulis

Department of General Surgery, University General Hospita, Patras, Greece

Abstract

Aim
To identify risk factors for developing surgical site infections (SSIs) based on a prospective study of patients undergoing colorectal surgery.
Methods
Between November 2019 and January 2021, 133 patients underwent elective operation for colorectal cancer in our institution. The following variables were recorded for each patient: age, gender, body mass index (BMI), American Society of Anesthesiologists Classification (ASA class), duration of surgery, wound classification, skin preparation regimens, surgical approach, comorbidities (hypertension, diabetes, cardiovascular disease, respiratory disease, chronic steroid use), and pathogens responsible for surgical site infection. Univariate analysis was performed using χ2 tests for categorical variables.
Results
A total of 65 males and 68 females were enrolled. Postoperative SSI was diagnosed in 29 (21.8%) cases. Fifty five patients were >70 years old, and SSIs were significantly more frequent in this group (p=0.033). There were 92 patients with BMI <30kg/m2 and 87 with ASA class ≤2; SSIs occurred significantly less frequently in these patients (p=0.021 and p=0.028, respectively). Open surgery was performed in 113 patients; 35 (out of 113; 31%) wound infections were classified as contaminated or dirty, and SSI occurred more often in these two groups (p=0.048 and p=0.037, respectively). Nineteen patients had diabetes and 36 used steroids continuously; SSI was significantly more frequent in these patients
(p=0.021 and p=0.049, respectively).
Conclusion
Following colorectal cancer procedures SSIs were significantly more common among patients over 70 years old,
BMI≥30kg/m2, ASA score>2, with diabetes and chronic steroid use, undergoing open, dirty or contaminated surgery. Escherichia coli and Enterococcus spp. were the two most common pathogens isolated.

References

1.
Pedroso-Fernandez Y, Aguirre-Jaime A, Ramos M, Hernández M, Cuervo M, Bravo A, et al. Prediction of surgical site infection after colorectal surgery. Am J Infect Control. 2016. p. 450–4.
2.
Hou T, Gan H, Zhou J, Gong Y, Li L, Zhang X, et al. Incidence of and risk factors for surgical site infection after colorectal surgery: A multiple-center prospective study of 3,663 consecutive patients in China. Int J Infect Dis. 2020. p. 676–81.
3.
Collaborative G. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. Lancet Infect Dis. 2018. p. 516–25.
4.
Kamboj M, Childers T, Sugalski J, Antonelli D, Bingener-Casey J, Cannon J, et al. Risk of Surgical Site Infection (SSI) following Colorectal Resection Is Higher in Patients With Disseminated Cancer: An NCCN Member Cohort Study. Infect Control Hosp Epidemiol. 2018. p. 555–62.
5.
Turner M, Migaly J. Surgical site infection: the clinical and economic impact. Clin Colon Rectal Surg. 2019. p. 157–65.
6.
Banaszkiewicz Z, Cierzniakowska K, Tojek K, Kozłowska E, Jawień A. Surgical site infection among patients after colorectal cancer surgery. Pol Przegl Chir. 2017. p. 9–15.
7.
Young P, Khadaroo R. Surgical site infections. Surg Clin North Am. 2014. p. 1245–64.
8.
Hedrick T, Sawyer R, Hennessy S, Turrentine F, Friel C. Can we define surgical site infection accurately in colorectal surgery? Surg Infect (Larchmt). 2014. p. 372–6.
9.
Pochhammer J, Köhler J, Schäffer M. Colorectal surgical site infections and their causative pathogens: differences between left-and right-side resections. Surg Infect (Larchmt). 2019. p. 62–70.
10.
Du M, Liu B, Li M, Cao J, Liu D, Wang Z, et al. Multicenter surveillance study of surgical site infection and its risk factors in radical resection of colon or rectal carcinoma. BMC Infect Dis. 2019. p. 411.
11.
Mulita F, Karpetas G, Liolis E, Vailas M, Tchabashvili L, Maroulis I. Comparison of analgesic efficacy of acetaminophen monotherapy versus acetaminophen combinations with either pethidine or parecoxib in patients undergoing laparoscopic cholecystectomy: a randomized prospective study. Med Glas (Zenica). 2021.
12.
Morikane K, Honda H, Yamagishi T, Suzuki S, Aminaka M. Factors associated with surgical site infection in colorectal surgery: the Japan nosocomial infections surveillance. Infect Control Hosp Epidemiol. 2014. p. 660–6.
13.
Gantz O, Zagadailov P, Merchant A. The cost of surgical site infections after colorectal surgery in the United States from 2001 to 2012: a longitudinal analysis. Am Surg. 2019. p. 142–9.
14.
Sanger P, Van Ramshorst G, Mercan E, Huang S, Hartzler A, Armstrong C, et al. A prognostic model of surgical site infection using daily clinical wound assessment. J Am Coll Surg. 2016. p. 259–70.
15.
Ju M, Ko C, Hall B, Bosk C, Bilimoria K, Wick E. A comparison of 2 surgical site infection monitoring systems. JAMA Surg. 2015. p. 51–7.
16.
Serra-Aracil X, García-Domingo M, Parés D, Espin-Basany E, Biondo S, Guirao X, et al. Surgical site infection in elective operations for colorectal cancer after the application of preventive measures. Arch Surg. 2011. p. 606–12.
17.
Wenzel R. Surgical site infections and the microbiome: An updated perspective. Infect Control Hosp Epidemiol. 2019. p. 590–6.
18.
Darouiche R, Wall M, Jr, Itani K, Otterson M, Webb A, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med. 2010. p. 18–26.
19.
Aimaq R, Akopian G, Kaufman H. Surgical site infection rates in laparoscopic versus open colorectal surgery. Am Surg. 2011. p. 1290–4.
20.
Blumetti J, Luu M, Sarosi G, Hartless K, Mcfarlin J, Parker B, et al. Surgical site infections after colorectal surgery: do risk factors vary depending on the type of infection considered. Surgery. 2007. p. 704–11.
21.
Bayar B, Yılmaz K, Akıncı M, Şahin A, Kulaçoğlu H. An evaluation of treatment results of emergency versus elective surgery in colorectal cancer patients. Ulus Cerrahi Derg. 2015. p. 11–7.

Citation

Authors retain copyright. This work is licensed under a Creative Commons Attribution 4.0 International License. Creative Commons License

 

Article metrics

Google scholar: See link

The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.