Prevalencia y análisis de factores de infección de sitio quirúrgico en clínica de heridas / Prevalence and Analysis of Surgical Site Infection Factors in Wound Clinic

Introducción: La infección de herida quirúrgica causa altas tasas de morbilidad y repercute sobre los índices de mortalidad. Constituye la primera infección intrahospitalaria entre pacientes quirúrgicos del total de infecciones nosocomiales y la primera entre los pacientes quirúrgicos. Existen factores de riesgo como la clasificación ASA, la diabetes mellitus, la hipertensión arterial y los días de estancia hospitalaria, los cuales influyen en su desarrollo. Objetivo: Determinar la prevalencia de infecciones de sitio quirúrgico por cirugías realizadas en el Hospital Dr. Carlos Canseco de Tampico, ciudad del estado mexicano de Tamaulipas. Métodos: Diseño observacional, analítico, transversal y retrospectivo de 54 pacientes con diagnóstico de infección de sitio quirúrgico. Las variables de estudio se clasificaron como dependientes (género, edad, lugar de origen, días de estancia hospitalaria, peso, índice de masa corporal) e independientes (diagnóstico, procedimiento quirúrgico realizado y clasificación ASA otorgada). Resultados: La población de 40 a 50 años fue la más afectada, con mayor predominancia sobre el género femenino. La Clasificación ASA II y III presentaron mayor prevalencia de infección de sitio quirúrgico, sobre todo en cirugías electivas (28 por ciento). Mientras mayor fue la estancia hospitalaria, mayor fue la probabilidad de desarrollar infección de sitio quirúrgico. Conclusiones: La prevalencia de infección en el sitio quirúrgico en pacientes operados por los distintos servicios quirúrgicos no es similar a la reportada por otros autores. La Clasificación ASA II y III presentaron infección del sitio quirúrgico con más frecuencia, mientras que la comorbilidad más llamativa de este estudio fue el índice de masa corporal como factor de riesgo que no debe pasar desapercibido(AU)

Introduction: Surgical wound infection causes high morbidity rates and impacts mortality rates. It is the first in-hospital infection among surgical patients of all nosocomial infections and the first among surgical patients. There are risk factors that influence its development, such as the ASA classification, diabetes mellitus, arterial hypertension and days of hospital stay. Objective: To determine the prevalence of surgical site infections from surgeries performed at Hospital Dr. Carlos Canseco, of Tampico, a city in the Mexican state of Tamaulipas. Methods: An observational, analytical, cross-sectional and retrospective study was carried out with 54 patients with a diagnosis of surgical site infection. The study variables were classified as dependent variables (gender, age, place of origin, days of hospital stay, weight and body mass index) and independent variables (diagnosis, surgical procedure performed, and given ASA classification). Results: The population aged 40 to 50 years was the most affected, with a greater predominance of the female gender. ASA classification II and III had a higher prevalence of surgical site infection, above all in elective surgeries (28 %). The longer the hospital stay, the higher the probability of developing surgical site infection. Conclusions: The prevalence of surgical site infection in patients operated on by the different surgical services is not similar to that reported by other authors. ASA Classification II and III presented surgical site infection more frequently, while the most remarkable comorbidity in this study was body mass index as a risk factor that should not go unnoticed(AU)

Influence of surgical site infection on oncological prognosis after curative resection for colorectal cancer: An observational single-institution study.

BACKGROUND: An exacerbated inflammatory response to post-operative infection could favor an environment in which residual viable tumor cells present in the surgical bed, bloodstream, or occult micrometastases can survive and progress to produce local or distant recurrence. In this regard, a surgical site infection (SSI) could be an important risk factor for disease progression. This study aimed to investigate the impact of SSI on long-term survival and recurrence of colorectal cancer. METHODS: Patients who underwent curative-intent resection for colorectal carcinoma between 2011 and 2013 were retrospectively analyzed. Overall and disease-free survival (DFS) and local recurrence rate for patients with and without SSI were analyzed. RESULTS: One hundred and thirty-eight patients were included in the study. Fifty-one (37%) patients showed SSI but revealed no differences in recurrence rate and overall survival compared with non-infected patients. However, the stratified analysis revealed that patients with an intra-abdominal abscess or an organ-space-infection showed a higher recurrence rate and a decreased 5-year overall and DFS. CONCLUSIONS: SSI may have an influence on the oncological prognosis and, therefore, could be considered a recurrence factor. Further multi-institutional studies are necessary to conclude a causal association.

ANTECEDENTES: Una respuesta inflamatoria exacerbada por una infección postoperatoria podría favorecer un entorno en el que células tumorales residuales viables presentes en el lecho quirúrgico, torrente sanguíneo o micrometástasis ocultas puedan sobrevivir y progresar para producir una recurrencia local o a distancia. En este sentido, una infección del sitio quirúrgico (ISQ) podría ser un factor de riesgo de progresión de la enfermedad. Este estudio tuvo como objetivo investigar el impacto de la ISQ en la supervivencia y recurrencia del cáncer colorrectal. MÉTODO: Todos los pacientes con carcinoma colorrectal sometidos a resección con intención curativa entre 2011 y 2013 fueron analizados retrospectivamente. Se analizó supervivencia global y libre de enfermedad y la tasa de recurrencia local en pacientes con cáncer colorrectal con y sin ISQ. RESULTADOS: Se incluyeron 138 pacientes. 51 (37%) sufrieron ISQ pero no mostraron diferencias en la tasa de recurrencia y supervivencia global respecto a los pacientes no infectados. Sin embargo, el análisis estratificado reveló que los pacientes con un absceso intraabdominal o una infección órgano-espacio mostraron una tasa de recurrencia más alta y una disminución en la supervivencia global y libre de enfermedad. CONCLUSIONES: La ISQ, en función de la gravedad y la respuesta inflamatoria que genera, puede influir en el pronóstico oncológico y, por lo tanto, podría considerarse un factor de recurrencia. Futuros estudios multicéntricos son necesarios para demostrar una posible asociación.

Incidence of surgical site infection in colon surgery according to RENAVE methodology: Prospective study 2017-2019. / Incidencia de infección de localización quirúrgica en cirugía de colon según metodología RENAVE: estudio prospectivo 2017-2019.

BACKGROUND: Navarra Hospital Complex has renovated its healthcare-associated infections surveillance and control methods meeting the requirements of the Spanish National Epidemiologic Surveillance Network. Surgical site infections are one of the most relevant adverse outcomes, being the colon surgery one of the mandatory monitored procedures. This system will ease, not only the yearly estimation of the hospital surgical infection rates, but also its comparison at national and European levels. METHODS: 416 patients underwent surgery between 2017 and 2019. Clinical variables were gathered during the patient hospitalization and up to 30days from surgery, stratifying the cases by their NHSN (National Health Safety Network) surgical infection risk index. A univariant descriptive analysis was performed and outcome indicators were estimated. RESULTS: The cumulative incidence was 10.6%, with 44 cases. The rates were higher among the high-risk subgroups: 25.0% and 42.9%, respectively, for NSHN index categories2 and3. CONCLUSIONS: The incidence was similar to the ones found in other studies carried out in analogous conditions. However, the methodologic variability makes it difficult to compare results.

Surgical site infection by carbapenemase-producing Enterobacteriaceae. A challenge for today's surgeons. / Infección de sitio quirúrgico asociada a enterobacterias productoras de carbapenemasas. Un desafío para el cirujano actual.

INTRODUCTION: Infections caused by carbapenemase-producing Enterobacteriaceae (CPE) are dramatically increasing worldwide, with an important impact on surgical patients. Our aim was to assess the clinical profile, outcomes, treatment, mortality and costs of CPE-related surgical site infection (SSI) in patients with abdominal surgery. METHODS: Review of CPE-related SSI in patients with abdominal surgery from January 2013 to December 2018. Patient factors and interventions present previously to the SSI identification were recorded, and a mortality analysis was also performed in patients with abdominal surgery and CPE-related organ/space SSI. RESULTS: Fifty patients were included: superficial incisional SSI 50%, deep incisional SSI 28%, organ/space SSI (or intra-abdominal infection) 70%. Klebsiella pneumoniae OXA-48 was present in 84%, and the most frequent were colorectal surgery (40%) and pancreatic surgery (20%). The antimicrobial susceptibility was: ceftazidime-avibactam 100%, amikacin 91.7%, tigecycline 89.1%, colistin 70.8%, meropenem 62.8%, imipenem 52.1%. An appropriate definitive antimicrobial treatment was administered in 86%, using a combined scheme in 76%. Global 30-day mortality rate for intra-abdominal infection was 20%, and mortality-related factors were: solid tumour (P=.009), solid metastasis (P=.009), septic shock (P=.02), blood transfusions (P=.03). Median global stay was 45 (IQR 26-67) days. Median global cost of hospitalization was €29,946 (IQR 15,405-47,749). CONCLUSIONS: The clinical profile of patients with CPE-related SSI associates several comorbidities, interventions, prolonged stay and elevated costs. Mortality-related factors in intra-abdominal infection are solid tumour, metastasis, septic shock or blood transfusions.

Uso de antibióticos profilácticos en pacientes sometidos a cirugías electivas limpias. Estudio prospectivo comparativo / Use of prophylactic antibiotics in patients undergoing clean elective surgeries. Comparative prospective study

El uso indiscriminado de antibióticos y el mal manejo de los mismos por parte del personal médico es un problema frecuente a nivel mundial, esto ha incrementado la resistencia bacteriana, los costos del tratamiento y ha creado la necesidad de contar con nuevos antibióticos, frecuentemente más costosos y de mayor toxicidad.Objetivo : evaluar el uso de antibióticos profilácticos en pacientes sometidos a cirugías electivas limpias, en centros privados del estado Aragua, en el periodo comprendido entre febrero y agosto del año 2019.Métodos : estudio prospectivo, observacional, comparativo, longitudinal. La muestra fue no probabilística intencional, se dividió en 2 grupos: grupo A, a quienes se les administró antibioticoterapia profiláctica, y un grupo B, a quienes no se les administró antibiótico.Resultados : Se incluyeron 49 pacientes sometidos a cirugías electivas limpias de tipo colecistectomías (14/28.57%), herniorrafía umbilical (6/12.24%) y hernioplastia inguinal (29/59.18%). La edad promedio fue de 37,7±12,17 años. Predomino el sexo masculino. Al quinto día del postoperatorio no se observaron signos de complicación infecciosa en los grupos A y B. Al décimo día de postoperatorio se observaron signos de complicación infecciosa en un paciente (4.3%) perteneciente al grupo A. No se observó complicación infecciosa en el grupo sin administración de antibiótico, grupo B.Conclusión : La indicación y mantenimiento por 7-10 días de antibiótico profiláctico en cirugía limpia no presenta diferencia en la presentación de complicaciones infecciosas comparado con la no administración de antibióticos para este tipo de cirugía, con el riesgo potencial de producción de efectos adversos y desarrollo de resistencia bacteriana(AU)

The indiscriminate use of antibiotics and their mishandling by medical personnel is a frequent problem worldwide, which has increased bacterial resistance, treatment costs and the need for new antibiotics, often more expensive and of greater toxicity.Objective : to evaluate the use of prophylactic antibiotics in patients undergoing clean elective surgeries, in private centers in the Aragua state, in the period between February and August of 2019.Methods : we conducted a prospective, longitudinal, observational, analytical epidemiological clinical study. The participants consisted of non-probabilistic sample of the intentional type of 49 patients of the total study population, undergoing elective surgery, cholecystectomy (14 / 28.57%), umbilical herniorrhaphy (6 / 12.24%) and inguinal hernioplasty (29 /59.18%). The sample was classified into 2 groups, a group A, who received prophylactic antibiotic therapy and a group B, who did not receive it.Results : the mean age was 37.7 ± 12.17 years, predominantly male. On the fifth day of the postoperative period, no signs of infectious complication were observed neither in group A nor in group B. On the tenth day after the postoperative period, signs of infectious complication were observed in one patient (4.3%) belonging to the antibiotic administration group. No infectious complication was observed in the group without antibiotic administration.Conclusion : it was confirmed that the administration of antibiotics does not reduce the incidence of infection, when comparing an experimental group with a control group(AU)

[Efecto de un Plan de Mejora de Calidad y Seguridad Clínica en la incidencia de infección de sitio quirúrgico en apendicectomía. Estudio cuasi-experimental]. / Effect of a Plan for Quality Improvement and Clinical Safety in the incidence of surgical site infections in appendectomy. A quasi-experimental study.

OBJETIVO: Las infecciones de sitio quirúrgico se pueden evitar y los programas de control basados en paquetes de medidas preventivas son eficaces para reducir su incidencia. El objetivo de este estudio fue evaluar el efecto de un Plan de Mejora de Calidad y Seguridad Clínica del paciente intervenido de apendicectomía en la incidencia de infección del sitio quirúrgico. MÉTODO: Se realizó un estudio cuasi-experimental con análisis antes y después de la introducción de un Plan de Calidad y Seguridad Clínica. Se incluyeron pacientes intervenidos de apendicectomía. Se estudió la incidencia de infección del sitio quirúrgico durante los 30 días posteriores a la cirugía (periodo máximo de incubación de infección quirúrgica). Se evaluó el efecto de la intervención con la odds ratio (OR) ajustada con un modelo de regresión logística. RESULTADOS: Se incluyeron 606 pacientes, 267 en el periodo 2009-2010 (antes del plan) y 339 durante 2012-2013 (después del plan). La incidencia de infección del sitio quirúrgico descendió después del plan del 6 al 5.6% (OR: 0.72; intervalo de confianza del 95%: 0.33-1.56; p = 0.839). Hubo mayor cumplimiento de la profilaxis antibiótica, de la preparación prequirúrgica y de la adherencia a la higiene de manos tras la introducción de las medidas. CONCLUSIONES: Aunque la reducción de la incidencia de infección del sitio quirúrgico no presentó diferencias estadísticamente significativas tras las medidas adoptadas, se ha conseguido mejorar la administración de la profilaxis antibiótica, la adherencia a la higiene de manos y la preparación prequirúrgica. OBJECTIVE: Surgical site infections can be prevented. Control programs based on care bundle have proven to be effective in reducing its incidence. The objective of this study was to assess the effectiveness of a Plan for Quality Improvement and Clinical Safety in preventing the incidence of surgical site infection in patients undergoing appendectomy. METHOD: A quasi-experimental study was designed for analysis before and after the introduction of a Plan for Quality and Clinical Safety. Patients undergoing appendectomy were included. The incidence of surgical site infection was studied within 30 days from the time of surgery (maximum incubation period of surgical site infection). The effectiveness of the intervention was evaluated using the odds ratio (OR) adjusted with a logistic regression model. RESULTS: A total of 606 patients were included, of which 267 were operated in the period 2009-2010 (before the plan) and 339 in 2012-2013 (after the plan). The incidence of surgical site ­infection decreased after the plan from 6 to 5.6% (OR: 0.72; 95% confidence interval: 0.33-1.56; p = 0.839). There was greater compliance of antibiotic prophylaxis, preoperative preparation and adherence to hand hygiene after the introduction of the measures. CONCLUSIONS: Although the reduction in the incidence of surgical site infection after the measures adopted did not show statistical significant differences, important progress has been made in the compliance of antibiotic prophylaxis, adherence to hand hygiene and in the preoperative preparation.

Incidence of surgical site infection and risk factors in rectal surgery: A prospective cohort study. / Incidencia de infección de sitio quirúrgico y factores de riesgo en cirugía de recto. Estudio de cohortes prospectivo.

INTRODUCTION: Surgical site infection (SSI) is the main cause of nosocomial infection in Spain. The aim of this study was to analyze the incidence of SSI and to evaluate its risk factors in patients undergoing rectal surgery. METHODS: Prospective cohort study, conducted from January 2013 to December 2016. Patient, surgical intervention and infection variables were collected. Infection rate was calculated after a maximum period of 30 days of incubation. The effect of different risk factors on infection was assessed using the odds ratio adjusted by a logistic regression model. RESULTS: The study included 154 patients, with a mean age of 69.5±12 years. The most common comorbidities were diabetes mellitus (24.5%), chronic obstructive pulmonary disease (17%) and obesity (12.6%). The overall incidence of SSI during the follow-up period was 11.9% (CI95%: 7.8-17.9) and the most frequent microorganism was Escherichia coli (57.9%). Risk factors associated with surgical wound infection in the univariate analysis were blood transfusion, drain tubes and vasoactive drug administration (P<.05). CONCLUSIONS: The incidence of SSI in rectal surgery was low. It is crucial to assess SSI incidence rates and to identify possible risk factors for infection. We recommend implementing surveillance and hospital control programs.

Prevention of Surgical Site Infection: Analysis and Narrative Review of Clinical Practice Guidelines. / Prevención de la infección de sitio quirúrgico: análisis y revisión narrativa de las guías de práctica clínica.

Surgical site infection is one of the most prevalent healthcare-associated infections and presents a considerable morbidity. The aim of this comprehensive narrative review is to describe the evidence and grade of recommendation of the preventive measures developed in the three phases of the surgical process (preoperative, perioperative and postoperative phases), as well as coincidences and divergences between selected Clinical Practice Guidelines (CPG). Four preventive measures were recommended with similar high grade evidence in all CPG: Hair removal, antibiotic prophylaxis, surgical site preparation and normothermia. However, critical points, new preventive measures and bundle implementations by surgical process are under discussion. These results represent a significant progress toward improving programs to prevent surgical site infection and they should be taken into account for improved future interventions in this area.

[Prevention of surgical site infection in abdominal surgery. A critical review of the evidence]. / Medidas de prevención de la infección del sitio quirúrgico en cirugía abdominal. Revisión crítica de la evidencia.

Surgical site infection (SSI) is associated with prolonged hospital stay, increased morbidity, mortality and sanitary costs, and reduced patients quality of life. Many hospitals have adopted guidelines of scientifically-validated processes for prevention of surgical site and central-line catheter infections and sepsis. Most of these guidelines have resulted in an improvement in postoperative results. A review of the best available evidence on these measures in abdominal surgery is presented. The best measures are: avoidance of hair removal from the surgical field, skin decontamination with alcoholic antiseptic, correct use of antibiotic prophylaxis (administration within 30-60 min before incision, use of 1(st) or 2(nd) generation cephalosporins, single preoperative dosis, dosage adjustments based on body weight and renal function, intraoperative re-dosing if the duration of the procedure exceeds 2 half-lives of the drug or there is excessive blood loss), prevention of hypothermia, control of perioperative glucose levels, avoid blood transfusion and restrict intraoperative liquid infusion.

[Post-appendectomy surgical site infection: overall rate and type according to open/laparoscopic approach]. / Infección de sitio quirúrgico tras apendicectomía urgente: tasa global y tipo según la vía de abordaje (abierta/laparoscópica).

OBJECTIVE: To compare the incidence and profile of surgical site infection (SSI) after laparoscopic (LA) or open (OA) appendicectomy. MATERIAL AND METHOD: Observational and analytical study was conducted on patients older than 14years-old with suspected acute appendicitis operated on within a 4-year period (2007-2010) at a third level hospital (n=868). They were divided in two groups according to the type of appendicectomy (LA, study group, 135; OA, control group, 733). The primary endpoint was a surgical site infection (SSI), and to determine the overall rate and types (incisional/organ-space). The risk of SSI was stratified by: i)National Nosocomial Infection Surveillance (NNIS) index (low risk: 0E, 0 and 1; high risk: 2 and 3); ii)status on presentation (low risk: normal or phlegmonous; high risk: gangrenous or perforated). The statistical analysis was performed using the software SPSS. The main result and stratified analysis was determined with χ(2), and the risk parameters using OR and Mantel-Haenszel OR with 95%CI, accepting statistical significance with P<.05. RESULTS: Age, gender, ASA index and incidence of advanced cases were similar in both groups. The overall SSI rate was 13.4% (more than a half of them detected during follow-up after discharge). Type of SSI: OA, 13% (superficial 9%, deep 2%, organ-space 2%); AL, 14% (superficial 5%, deep 1%, organ-space 8%) (overall: not significant; distribution: P<.000). Stratified analysis showed that there is an association between incisional SSI/OA and organ-space SSI/LA, and is particularly stronger in those patients with high risk of postoperative SSI (high risk NNIS or gangrenous-perforated presentation). CONCLUSION: OA and LA are associated with a higher rate of incisional and organ-space SSI respectively. This is particularly evident in patients with high risk of SSI.

Comparación de dos esquemas antibióticos en infección de sitio quirúrgico en niños / Comparison between two antibiotic schemes in relation to surgical site infection in children: a randomized clinical trial

Introducción: Hay pocos estudios controlados que prueben la efectividad de la profilaxis antibiótica para prevenir infección de sitio quirúrgico en niños. El objetivo de esta investigación es determinar la efectividad de la profilaxis antibiótica contra esquema tradicional de antibióticos. Material y métodos: Ensayo clínico controlado llevado a cabo en el Departamento de Cirugía General en hospital pediátrico de tercer nivel, de 187 casos consecutivos menores de 18 años, con herida limpia o limpia-contaminada, entre enero de 2005 y diciembre de 2006. Se excluyeron los pacientes con cicatriz previa, quienes habían recibido antibióticos o que no proporcionaron su consentimiento informado. A un grupo (experimental) se administró cefalotina o clindamicina más amikacina dos horas antes de la incisión y por 24 horas y a otro se le administraron los mismos antibióticos durante o después de incisión y por cinco días. Se determinó el número de infecciones de sitio quirúrgico en procedimientos limpios y limpios contaminados. Resultados: Se excluyeron 16 pacientes. El grupo experimental incluyó 26 procedimientos limpios y 54 limpios contaminados y el grupo control, 27 y 64, respectivamente. El grupo experimental tuvo menos incidencia de infección de sitio quirúrgico (1 de 80 [1.2 %] contra 10 de 91 [10.9 %]), RR = 9.7, IC 95 % = 1.2-77.9, p = 0.009. Dicha diferencia basada en los procedimientos limpios contaminados. Conclusiones: La profilaxis antibiótica administrada dos horas antes de incidir y por 24 horas disminuyó significativamente la incidencia de infección de sitio quirúrgico en heridas limpias contaminadas.

BACKGROUND: There are few randomized clinical trials that prove the effectiveness of antibiotic prophylaxis (AP) to prevent pediatric surgical site infections (SSI). We undertook this study to determine the effectiveness of AP vs. traditional scheme of antibiotics. METHODS: We carried out a randomized clinical trial at the General Surgery Department of a Tertiary Care Children's Hospital in Mexico City. There were 187 consecutive patients, age 18 years or less, with clean or clean-contaminated procedures performed between January 2005 and December 2006. Exclusion criteria included previous scar on operated site, receiving antibiotics, or no informed consent. Cefalotin or clindamycin plus amikacin was administered 2 h before incision, continued for just 24 h in the experimental group (EG) vs. cefalotin or clindamycin plus amikacin administered just before, during or after incision and continuing for 5 days (control group, CG). RESULTS: Sixteen patients were excluded. EG included 26 clean and 54 clean-contaminated procedures, and in the CG there were 27 and 64 procedures, respectively. EG had a lower incidence of SSI (1/80 [1.2 %] vs. 10/91 [10.9 %], RR 9.7, (95% CI: 1.2-77.9, p = 0.009). The difference is based mainly on the clean-contaminated procedures. CONCLUSIONS: AP administered 2 h before incision and continuing for 24 h significantly decreases the risk of SSI compared to CG in clean-contaminated procedures.