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Stavropoulou E, Atkinson A, Eisenring MC, Fux CA, Marschall J, Senn L, Troillet N. Association of antimicrobial perioperative prophylaxis with cefuroxime plus metronidazole or amoxicillin/clavulanic acid and surgical site infections in colorectal surgery. Antimicrob Resist Infect Control 2023; 12:105. [PMID: 37726838 PMCID: PMC10510121 DOI: 10.1186/s13756-023-01307-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE To compare intravenous (IV) amoxicillin/clavulanic acid (A/CA) to IV cefuroxime plus metronidazole (C + M) for preventing surgical site infections (SSI) in colorectal surgery. BACKGROUND Given their spectra that include most Enterobacterales and anaerobes, C + M is commonly recommended as prophylaxis of SSI in colorectal surgery. A/CA offers good coverage of Enterobacterales and anaerobes as well, but, in contrast to C + M, it also includes Enterococcus faecalis which is also isolated from patients with SSI and could trigger anastomotic leakage. METHODS Data from a Swiss SSI surveillance program were used to compare SSI rates after class II (clean contaminated) colorectal surgery between patients who received C + M and those who received A/CA. We employed multivariable logistic regression to adjust for potential confounders, along with propensity score matching to adjust for group imbalance. RESULTS From 2009 to 2018, 27,922 patients from 127 hospitals were included. SSI was diagnosed in 3132 (11.2%): 278/1835 (15.1%) in those who received A/CA and 2854/26,087 (10.9%) in those who received C + M (p < 0.001). The crude OR for SSI in the A/CA group as compared to C + M was 1.45 [CI 95% 1.21-1.75]. The adjusted OR was 1.49 [1.24-1.78]. This finding persisted in a 1:1 propensity score matched cohort of 1835 patients pairs with an OR of 1.60 [1.28-2.00]. Other factors independently associated with SSI were an ASA score > 2, a longer duration of operation, and a reoperation for a non-infectious complication. Protective factors were female sex, older age, antibiotic prophylaxis received 60 to 30 min before surgery, elective operation, and endoscopic approach. CONCLUSIONS Despite its activity against enterococci, A/CA was less effective than C + M for preventing SSI, suggesting that it should not be a first choice antibiotic prophylaxis for colorectal surgery.
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Affiliation(s)
- Elisavet Stavropoulou
- Service of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
- Service of Infectious Diseases, Department of Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Marie-Christine Eisenring
- Service of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
- Swissnoso, National Center for Infection Prevention, Bern, Switzerland
| | - Christoph A Fux
- Division of Infectious Diseases and Infection Prevention, Kantonsspital Aarau, Aarau, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Laurence Senn
- Swissnoso, National Center for Infection Prevention, Bern, Switzerland.
- Infection Prevention and Control Unit, Service of Infectious Diseases, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
| | - Nicolas Troillet
- Service of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
- Swissnoso, National Center for Infection Prevention, Bern, Switzerland
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Atkinson A, Troillet N, Widmer A, Eisenring MC, Kuster S, Zwahlen M, Marschall J. 1233. Surveillance Quality Correlates with SSI Rates in Prosthetic Hip and Knee Surgery: A Call to Action to Adjust Reporting of SSI rates. Open Forum Infect Dis 2019. [PMCID: PMC6809014 DOI: 10.1093/ofid/ofz360.1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
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Affiliation(s)
| | | | - Andreas Widmer
- University Hospital Basel, Basel, Basel-Stadt, Switzerland
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Buetti N, Atkinson A, Troillet N, Eisenring MC, Zwahlen M, Kuster SP, Widmer A, Marschall J. 2137. Risk Factors for Surgical Site Infection After Joint Replacement Surgery: Data from the Swiss National Surveillance System. Open Forum Infect Dis 2018. [PMCID: PMC6253102 DOI: 10.1093/ofid/ofy210.1793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Surgical site infections (SSIs) are infrequently observed after joint replacement surgery but have devastating consequences. Since 2009, a large network of Swiss hospitals prospectively collects data for the national SSI surveillance system. The aim of this observational study was to identify risk factors for SSI among patients undergoing elective hip and knee arthroplastic procedures. Methods Risk factors for SSI were identified using both univariate and multivariate logistic regression, appropriately adjusted for hospital level correlation effects among the 173 participating hospitals. We included procedural characteristics and risk categories in our analysis. Results We analyzed a total of 113,495 joint replacement procedures that occurred between June 2009 and September 2017. A 12-month follow-up was completed in 92.5% of cases. Overall, the cumulative SSI rate was 1.3% (n = 1,458), varying from 1.1% for knee to 1.4% for hip arthroplasty. Repeat surgery (unplanned or planned), higher ASA level, and longer than anticipated procedural time were associated with a significantly increased risk of infection (figure). Ninety-one percent of all SSIs (1,328) were detected in the post-discharge follow-up. Risk factors for pre-discharge SSIs were very similar to those mentioned above. Fifty-six percent of SSIs were observed within 30 days, 27% from 30 to 90 days after incision and 17% were observed >90 days after the procedure. Conclusion The SSI incidence after joint replacement surgery was low, with no significant difference between knee and hip surgery. Almost all SSIs occurred post-discharge, with risk factors being broadly the same, independent of when the infection occurred. Limiting the follow-up period to 90 days would have resulted in missing 17% of SSIs, which argues in favor of extended follow-up. Disclosures A. Widmer, Swiss national science foundation: Grant Investigator, Grant recipient.
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Affiliation(s)
- Niccolo Buetti
- Infectious Diseases and Hospital Epidemiology, University Hospital Bern, Bern, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
| | | | | | - Marcel Zwahlen
- Institute for Social and Preventive Medicine, Bern, Switzerland
| | - Stefan P Kuster
- Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Jonas Marschall
- Infectious Diseases and Hospital Epidemiology, University Hospital Bern, Bern, Switzerland
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Abstract
BACKGROUND Surgical site infections (SSI) due to Staphylococcus aureus are associated with substantial mortality rates and morbidity. Hence, various strategies are being investigated to prevent them. We explore time trends and risk factors associated with S. aureus SSI to identify high risk patients who might benefit the most from these strategies. METHODS This is a retrospective cross-sectional study on a prospectively maintained database. We identified organism specific risk factors for S. aureus SSI as a whole, methicillin-sensitive S. aureus (MSSA), and methicillin-resistant S. aureus (MRSA). We also identified procedure-specific risk factors for S. aureus SSI for colectomy, hip, and knee arthroplasty, herniorrhaphy, and cholecystectomy. RESULTS We compared 249 patients with S. aureus SSI with 54,988 uninfected control patients. The rate of S. aureus SSI was steady throughout the study period with MSSA being more common than MRSA. Independent risk factors for S. aureus SSI from multivariable analysis were length of hospitalization prior to surgery [odds ratio (OR) 1.01; 95% confidence interval (CI), 1.00-1.02)], colectomy (OR 2.81; 95% CI, 1.94-4.07), hip or knee arthroplasty (OR 1.52; 95% CI, 1.04-2.21), extended duration of surgery (OR 1.61; 95% CI, 1.10-2.37), NNIS score of two or more (OR 2.04; 95% CI, 1.24-3.36), and re-interventions for non-infectious reasons (OR 1.82; 95% CI, 1.16-2.86). Minimally invasive (OR 0.21; 95% CI, 0.13-0.34) and emergency operations (OR 0.61; 95% CI, 0.41-0.92) were protective against S. aureus SSI. CONCLUSIONS Future S.aureus SSI prevention measures should focus on patients with risk profiles identified from this and other similar studies.
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Affiliation(s)
- Kalisvar Marimuthu
- 1 Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital , Singapore .,3 Infection Control Program and Faculty of Medicine, Geneva University Hospitals , Geneva, Switzerland
| | | | - Stephan Harbarth
- 3 Infection Control Program and Faculty of Medicine, Geneva University Hospitals , Geneva, Switzerland
| | - Nicolas Troillet
- 2 Service of Infectious Diseases, Central Institute of the Valais Hospitals , Sion, Switzerland .,4 Services of Infectious Diseases and Preventive Medicine, University Hospital of Lausanne , Lausanne, Switzerland
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Hübner M, Diana M, Zanetti G, Eisenring MC, Demartines N, Troillet N. Surgical site infections in colon surgery: the patient, the procedure, the hospital, and the surgeon. ACTA ACUST UNITED AC 2011; 146:1240-5. [PMID: 21768407 DOI: 10.1001/archsurg.2011.176] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the role of the surgeon in the occurrence of surgical site infection (SSI) following colon surgery, with respect to his or her adherence to guidelines and his or her experience. DESIGN, SETTING, AND PATIENTS Prospective cohort study of 2393 patients who underwent colon surgery performed by 31 surgeons in 9 secondary and tertiary care public Swiss hospitals, recruited from a surveillance program for SSI between March 1, 1998, and December 31, 2008, and followed up for 1 month after their operation. MAIN OUTCOME MEASURES Risk factors for SSI were identified in univariate and multivariate analyses that included the patients' and procedures' characteristics, the hospitals, and the surgeons as candidate covariates. Correlations were sought between surgeons' individual adjusted risks, their self-reported adherence to guidelines, and the delay since their board certification. RESULTS A total of 428 SSIs (17.9%) were identified, with hospital rates varying from 4.0% to 25.2% and individual surgeon rates varying from 3.7% to 36.1%. Features of the patients and procedures associated with SSI in univariate analyses were male sex, age, American Society of Anesthesiologists score, contamination class, operation duration, and emergency procedure. Correctly timed antibiotic prophylaxis and laparoscopic approach were protective. Multivariate analyses adjusting for these features and for the hospitals found 4 surgeons with higher risk of SSI (odds ratio [OR] = 2.37, 95% confidence interval [CI], 1.51-3.70; OR = 2.19, 95% CI, 1.41-3.39; OR = 2.15, 95% CI, 1.02-4.53; and OR = 1.97, 95% CI, 1.18-3.30) and 2 surgeons with lower risk of SSI (OR = 0.43, 95% CI, 0.19-0.94; and OR = 0.19, 95% CI, 0.04-0.81). No correlation was found between surgeons' individual adjusted risks and their adherence to guidelines or their experience. CONCLUSION For reasons beyond adherence to guidelines or experience, the surgeon may constitute an independent risk factor for SSI after colon surgery.
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Affiliation(s)
- Martin Hübner
- Department of Visceral Surgery University Hospital, Lausanne, Switzerland
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Luthi JC, Troillet N, Eisenring MC, Sax H, Burnand B, Quan H, Ghali W. Administrative data outperformed single-day chart review for comorbidity measure. Int J Qual Health Care 2007; 19:225-31. [PMID: 17599922 DOI: 10.1093/intqhc/mzm017] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of this article is to compare the Charlson comorbidity index derived from a rapid single-day chart review with the same index derived from administrative data to determine how well each predicted inpatient mortality and nosocomial infection. DESIGN Cross-sectional study. SETTING The study was conducted in the context of the Swiss Nosocomial Infection Prevalence (SNIP) study in six hospitals, canton of Valais, Switzerland, in 2002 and 2003. PARTICIPANTS We included 890 adult patients hospitalized from acute care wards. MAIN OUTCOME MEASURES The Charlson comorbidity index was recorded during one single-day for the SNIP study, and from administrative data (International Classification of Disease, 10th revision codes). Outcomes of interest were hospital mortality and nosocomial infection. RESULTS Out of 17 comorbidities from the Charlson index, 11 had higher prevalence in administrative data, 4 a lower and two a similar compared with the single-day chart review. Kappa values between both databases ranged from - 0.001 to 0.56. Using logistic regression to predict hospital outcomes, Charlson index derived from administrative data provided a higher C statistic compared with single-day chart review for hospital mortality (C = 0.863 and C = 0.795, respectively) and for nosocomial infection (C = 0.645 and C = 0.614, respectively). CONCLUSIONS The Charlson index derived from administrative data was superior to the index derived from rapid single-day chart review. We suggest therefore using administrative data, instead of single-day chart review, when assessing comorbidities in the context of the evaluation of nosocomial infections.
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Troillet N, Petignat C, Matter M, Eisenring MC, Mosimann F, Francioli P. [Surgical site infection surveillance: an effective preventive measure]. Rev Med Suisse Romande 2001; 121:125-8. [PMID: 11285692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Surgical site infection (SSI) is a feared complication of any surgical procedure. Despite clear progresses during the last decades, recent studies (some from Switzerland) show that many patients still suffer from SSIs and that SSIs have a huge impact for patients and public health. Thus, the prevention of SSIs must constitute a priority of nosocomial infections control in hospitals. In addition to classical approaches focusing on skin preparation, antibiotic prophylaxis, asepsis, and operative environment, surveillance has proved effective in decreasing the incidence of SSIs. The present paper reviews the principles and the main components of an SSI surveillance program.
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Affiliation(s)
- N Troillet
- Institut central des hôpitaux valaisans, Sion et CHUV, Lausanne.
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