Skip to main content
Erschienen in: Updates in Surgery 4/2020

14.09.2020 | COVID-19 | Original Article Zur Zeit gratis

Impact of lockdown for SARS-CoV-2 (COVID-19) on surgical site infection rates: a monocentric observational cohort study

verfasst von: Pasquale Losurdo, Lucia Paiano, Natasa Samardzic, Paola Germani, Laura Bernardi, Massimo Borelli, Barbara Pozzetto, Nicolò de Manzini, Marina Bortul

Erschienen in: Updates in Surgery | Ausgabe 4/2020

Einloggen, um Zugang zu erhalten

Abstract

Surgical site infections are the most common in-hospital acquired infections. The aim of this study and the primary endpoint is to evaluate how the measures to reduce the SARS-CoV-2 spreading affected the superficial and deep SSI rate. A total of 541 patients were included. Of those, 198 from March to April 2018, 220 from March till April 2019 and 123 in the COVID-19 era from March to April 2020. The primary endpoint occurred in 39 over 541 patients. In COVID-19 era, we reported a lower rate of global SSIs (3.3% vs. 8.4%; p 0.035), few patients developed a superficial SSIs (0.8% vs. 3.4%; p 0.018) and none experienced deep SSIs (0% vs. 3.4%; p 0.025). Comparing the previous two “COVID-19-free” years, no significative differences were reported. At multivariate analysis, the measures to reduce the SARS-CoV-2 spread (OR 0.368; p 0.05) were independently associated with the reduction for total, superficial and deep SSIs. Moreover, the presence of drains (OR 4.99; p 0.009) and a Type III–IV of SWC (OR 1.8; p 0.001) demonstrated a worse effect regarding the primary endpoint. Furthermore, the presence of the drain was not associated with an increased risk of superficial and deep SSIs. In this study, we provided important insights into the superficial and deep SSIs risk assessment for patients who underwent surgery. Simple and easily viable precautions such as wearing surgical masks and the restriction of visitors emerged as promising tools for the reduction of SSIs risk.
Literatur
1.
Zurück zum Zitat Itani KM (2015) Care bundles and prevention of surgical site infection in colorectal surgery. JAMA 314(3):289–290CrossRef Itani KM (2015) Care bundles and prevention of surgical site infection in colorectal surgery. JAMA 314(3):289–290CrossRef
2.
Zurück zum Zitat De Simone B, Sartelli M, Coccolini F et al (2020) Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines. World J Emerg Surg 15(1):10CrossRef De Simone B, Sartelli M, Coccolini F et al (2020) Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines. World J Emerg Surg 15(1):10CrossRef
3.
Zurück zum Zitat Ruiz-Tovar J, Llavero C, Morales V, Gamallo C (2018) Effect of the application of a bundle of three measures (intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples) on the surgical site infection after elective laparoscopic colorectal cancer surgery. Surg Endosc 32(8):3495–3501CrossRef Ruiz-Tovar J, Llavero C, Morales V, Gamallo C (2018) Effect of the application of a bundle of three measures (intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples) on the surgical site infection after elective laparoscopic colorectal cancer surgery. Surg Endosc 32(8):3495–3501CrossRef
4.
Zurück zum Zitat Hedenstierna G, Meyhoff CS, Perchiazzi G, Larsson A, Wetterslev J, Rasmussen LS (2019) Modification of the World Health Organization global guidelines for prevention of surgical site infection is needed. Anesthesiology 131(4):765–768CrossRef Hedenstierna G, Meyhoff CS, Perchiazzi G, Larsson A, Wetterslev J, Rasmussen LS (2019) Modification of the World Health Organization global guidelines for prevention of surgical site infection is needed. Anesthesiology 131(4):765–768CrossRef
6.
Zurück zum Zitat Liu Z, Dumville JC, Norman G et al (2018) Intraoperative interventions for preventing surgical site infection: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2:CD012653PubMed Liu Z, Dumville JC, Norman G et al (2018) Intraoperative interventions for preventing surgical site infection: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2:CD012653PubMed
7.
Zurück zum Zitat Sartelli M, Kluger Y, Ansaloni L et al (2018) Knowledge, awareness, and attitude towards infection prevention and management among surgeons: identifying the surgeon champion. World J Emerg Surg 13:37CrossRef Sartelli M, Kluger Y, Ansaloni L et al (2018) Knowledge, awareness, and attitude towards infection prevention and management among surgeons: identifying the surgeon champion. World J Emerg Surg 13:37CrossRef
8.
Zurück zum Zitat Thangaraju P, Venkatesan S (2019) Responding to the Global Guidelines for the Prevention of Surgical Site Infection, 2018: a focus on surgical antibiotic prophylaxis prolongation. J Res Med Sci 24:90CrossRef Thangaraju P, Venkatesan S (2019) Responding to the Global Guidelines for the Prevention of Surgical Site Infection, 2018: a focus on surgical antibiotic prophylaxis prolongation. J Res Med Sci 24:90CrossRef
9.
Zurück zum Zitat Sartelli M, Pagani L, Iannazzo S et al (2020) A proposal for a comprehensive approach to infections across the surgical pathway. World J Emerg Surg 15(1):13CrossRef Sartelli M, Pagani L, Iannazzo S et al (2020) A proposal for a comprehensive approach to infections across the surgical pathway. World J Emerg Surg 15(1):13CrossRef
11.
Zurück zum Zitat Ren YR, Golding A, Sorbello A et al (2020) A comprehensive updated review on SARS-CoV-2 and COVID-19. J Clin Pharmacol 60(8):954-975 Ren YR, Golding A, Sorbello A et al (2020) A comprehensive updated review on SARS-CoV-2 and COVID-19. J Clin Pharmacol 60(8):954-975
12.
Zurück zum Zitat MacIntyre CR, Zhang Y, Chughtai AA et al (2016) Cluster randomised controlled trial to examine medical mask use as source control for people with respiratory illness. BMJ Open 6(12):e012330CrossRef MacIntyre CR, Zhang Y, Chughtai AA et al (2016) Cluster randomised controlled trial to examine medical mask use as source control for people with respiratory illness. BMJ Open 6(12):e012330CrossRef
14.
Zurück zum Zitat Sorbello M, Di Giacinto I, Corso RM, Cataldo R (2020) Societa Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva Airway Management Research G. Prevention is better than the cure, but the cure cannot be worse than the disease: fibreoptic tracheal intubation in COVID-19 patients. Br J Anaesth 125(1):e187–e188 Sorbello M, Di Giacinto I, Corso RM, Cataldo R (2020) Societa Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva Airway Management Research G. Prevention is better than the cure, but the cure cannot be worse than the disease: fibreoptic tracheal intubation in COVID-19 patients. Br J Anaesth 125(1):e187–e188
15.
Zurück zum Zitat Sorbello M, El-Boghdadly K, Di Giacinto I et al (2020) The Italian coronavirus disease 2019 outbreak: recommendations from clinical practice. Anaesthesia 75(6):724–732CrossRef Sorbello M, El-Boghdadly K, Di Giacinto I et al (2020) The Italian coronavirus disease 2019 outbreak: recommendations from clinical practice. Anaesthesia 75(6):724–732CrossRef
17.
Zurück zum Zitat Ali-Mucheru MN, Seville MT, Miller V, Sampathkumar P, Etzioni DA (2020) Postoperative surgical site infections: understanding the discordance between surveillance systems. Ann Surg 271(1):94–99CrossRef Ali-Mucheru MN, Seville MT, Miller V, Sampathkumar P, Etzioni DA (2020) Postoperative surgical site infections: understanding the discordance between surveillance systems. Ann Surg 271(1):94–99CrossRef
18.
Zurück zum Zitat Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36(5):309–332CrossRef Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36(5):309–332CrossRef
19.
Zurück zum Zitat Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 20(5):271–274CrossRef Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 20(5):271–274CrossRef
20.
Zurück zum Zitat Losurdo P, Stolfo D, Merlo M et al (2016) Early arrhythmic events in idiopathic dilated cardiomyopathy. JACC Clin Electrophysiol 2(5):535–543CrossRef Losurdo P, Stolfo D, Merlo M et al (2016) Early arrhythmic events in idiopathic dilated cardiomyopathy. JACC Clin Electrophysiol 2(5):535–543CrossRef
21.
Zurück zum Zitat Steyerberg EW, Eijkemans MJ, Harrell FE Jr, Habbema JD (2001) Prognostic modeling with logistic regression analysis: in search of a sensible strategy in small data sets. Med Decis Making 21(1):45–56CrossRef Steyerberg EW, Eijkemans MJ, Harrell FE Jr, Habbema JD (2001) Prognostic modeling with logistic regression analysis: in search of a sensible strategy in small data sets. Med Decis Making 21(1):45–56CrossRef
22.
Zurück zum Zitat Heinze G, Ploner M, Beyea J (2013) Confidence intervals after multiple imputation: combining profile likelihood information from logistic regressions. Stat Med 32(29):5062–5076CrossRef Heinze G, Ploner M, Beyea J (2013) Confidence intervals after multiple imputation: combining profile likelihood information from logistic regressions. Stat Med 32(29):5062–5076CrossRef
23.
Zurück zum Zitat Strobl C, Malley J, Tutz G (2009) An introduction to recursive partitioning: rationale, application, and characteristics of classification and regression trees, bagging, and random forests. Psychol Methods 14(4):323–348CrossRef Strobl C, Malley J, Tutz G (2009) An introduction to recursive partitioning: rationale, application, and characteristics of classification and regression trees, bagging, and random forests. Psychol Methods 14(4):323–348CrossRef
24.
Zurück zum Zitat Anderson DJ, Podgorny K, Berrios-Torres SI et al (2014) Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 35(Suppl 2):S66–88CrossRef Anderson DJ, Podgorny K, Berrios-Torres SI et al (2014) Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 35(Suppl 2):S66–88CrossRef
25.
Zurück zum Zitat Tuuli MG, Liu J, Stout MJ et al (2016) A randomized trial comparing skin antiseptic agents at cesarean delivery. N Engl J Med 374(7):647–655CrossRef Tuuli MG, Liu J, Stout MJ et al (2016) A randomized trial comparing skin antiseptic agents at cesarean delivery. N Engl J Med 374(7):647–655CrossRef
26.
Zurück zum Zitat Fong ZV, McMillan MT, Marchegiani G et al (2016) Discordance between perioperative antibiotic prophylaxis and wound infection cultures in patients undergoing pancreaticoduodenectomy. JAMA Surg 151(5):432–439CrossRef Fong ZV, McMillan MT, Marchegiani G et al (2016) Discordance between perioperative antibiotic prophylaxis and wound infection cultures in patients undergoing pancreaticoduodenectomy. JAMA Surg 151(5):432–439CrossRef
27.
Zurück zum Zitat Broach RB, Paulson EC, Scott C, Mahmoud NN (2017) Randomized controlled trial of two alcohol-based preparations for surgical site antisepsis in colorectal surgery. Ann Surg 266(6):946–951CrossRef Broach RB, Paulson EC, Scott C, Mahmoud NN (2017) Randomized controlled trial of two alcohol-based preparations for surgical site antisepsis in colorectal surgery. Ann Surg 266(6):946–951CrossRef
28.
Zurück zum Zitat Ejaz A, Schmidt C, Johnston FM, Frank SM, Pawlik TM (2017) Risk factors and prediction model for inpatient surgical site infection after major abdominal surgery. J Surg Res 217:153–159CrossRef Ejaz A, Schmidt C, Johnston FM, Frank SM, Pawlik TM (2017) Risk factors and prediction model for inpatient surgical site infection after major abdominal surgery. J Surg Res 217:153–159CrossRef
29.
Zurück zum Zitat Poruk KE, Lin JA, Cooper MA et al (2016) A novel, validated risk score to predict surgical site infection after pancreaticoduodenectomy. HPB (Oxford) 18(11):893–899CrossRef Poruk KE, Lin JA, Cooper MA et al (2016) A novel, validated risk score to predict surgical site infection after pancreaticoduodenectomy. HPB (Oxford) 18(11):893–899CrossRef
30.
Zurück zum Zitat Badia JM, Casey AL, Petrosillo N, Hudson PM, Mitchell SA, Crosby C (2017) Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect 96(1):1–15CrossRef Badia JM, Casey AL, Petrosillo N, Hudson PM, Mitchell SA, Crosby C (2017) Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect 96(1):1–15CrossRef
31.
Zurück zum Zitat Lawson EH, Hall BL, Ko CY (2013) Risk factors for superficial vs deep/organ-space surgical site infections: implications for quality improvement initiatives. JAMA Surg 148(9):849–858CrossRef Lawson EH, Hall BL, Ko CY (2013) Risk factors for superficial vs deep/organ-space surgical site infections: implications for quality improvement initiatives. JAMA Surg 148(9):849–858CrossRef
32.
Zurück zum Zitat Blumetti J, Luu M, Sarosi G et al (2007) Surgical site infections after colorectal surgery: do risk factors vary depending on the type of infection considered? Surgery 142(5):704–711CrossRef Blumetti J, Luu M, Sarosi G et al (2007) Surgical site infections after colorectal surgery: do risk factors vary depending on the type of infection considered? Surgery 142(5):704–711CrossRef
33.
Zurück zum Zitat Mehta JA, Sable SA, Nagral S (2015) Updated recommendations for control of surgical site infections. Ann Surg 261(3):e65CrossRef Mehta JA, Sable SA, Nagral S (2015) Updated recommendations for control of surgical site infections. Ann Surg 261(3):e65CrossRef
34.
Zurück zum Zitat Englesbe MJ, Brooks L, Kubus J et al (2010) A statewide assessment of surgical site infection following colectomy: the role of oral antibiotics. Ann Surg. 252(3):514–519 (discussion 519-520)PubMedPubMedCentral Englesbe MJ, Brooks L, Kubus J et al (2010) A statewide assessment of surgical site infection following colectomy: the role of oral antibiotics. Ann Surg. 252(3):514–519 (discussion 519-520)PubMedPubMedCentral
35.
Zurück zum Zitat Guenaga KF, Matos D, Wille-Jorgensen P (2011) Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 2011(9):CD001544 Guenaga KF, Matos D, Wille-Jorgensen P (2011) Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 2011(9):CD001544
36.
Zurück zum Zitat Ingraham AM, Cohen ME, Bilimoria KY et al (2010) Association of surgical care improvement project infection-related process measure compliance with risk-adjusted outcomes: implications for quality measurement. J Am Coll Surg 211(6):705–714CrossRef Ingraham AM, Cohen ME, Bilimoria KY et al (2010) Association of surgical care improvement project infection-related process measure compliance with risk-adjusted outcomes: implications for quality measurement. J Am Coll Surg 211(6):705–714CrossRef
37.
Zurück zum Zitat Stulberg JJ, Delaney CP, Neuhauser DV, Aron DC, Fu P, Koroukian SM (2010) Adherence to surgical care improvement project measures and the association with postoperative infections. JAMA 303(24):2479–2485CrossRef Stulberg JJ, Delaney CP, Neuhauser DV, Aron DC, Fu P, Koroukian SM (2010) Adherence to surgical care improvement project measures and the association with postoperative infections. JAMA 303(24):2479–2485CrossRef
38.
Zurück zum Zitat Hawn MT, Vick CC, Richman J et al (2011) Surgical site infection prevention: time to move beyond the surgical care improvement program. Ann Surg 254(3):494–499CrossRef Hawn MT, Vick CC, Richman J et al (2011) Surgical site infection prevention: time to move beyond the surgical care improvement program. Ann Surg 254(3):494–499CrossRef
39.
Zurück zum Zitat Neumayer L, Hosokawa P, Itani K et al (2007) Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 204:1178–1187CrossRef Neumayer L, Hosokawa P, Itani K et al (2007) Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 204:1178–1187CrossRef
40.
Zurück zum Zitat Silvestri M, Dobrinja C, Scomersi S et al (2018) Modifiable and non-modifiable risk factors for surgical site infection after colorectal surgery: a single-center experience. Surg Today 48:338–345CrossRef Silvestri M, Dobrinja C, Scomersi S et al (2018) Modifiable and non-modifiable risk factors for surgical site infection after colorectal surgery: a single-center experience. Surg Today 48:338–345CrossRef
Metadaten
Titel
Impact of lockdown for SARS-CoV-2 (COVID-19) on surgical site infection rates: a monocentric observational cohort study
verfasst von
Pasquale Losurdo
Lucia Paiano
Natasa Samardzic
Paola Germani
Laura Bernardi
Massimo Borelli
Barbara Pozzetto
Nicolò de Manzini
Marina Bortul
Publikationsdatum
14.09.2020
Verlag
Springer International Publishing
Schlagwort
COVID-19
Erschienen in
Updates in Surgery / Ausgabe 4/2020
Print ISSN: 2038-131X
Elektronische ISSN: 2038-3312
DOI
https://doi.org/10.1007/s13304-020-00884-6

Weitere Artikel der Ausgabe 4/2020

Updates in Surgery 4/2020 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.