Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Konkret geht es um den Diabetes-Patienten mit kardiovaskulären Erkrankungen oder Risiken, die Herzinsuffizienz sowie die kardiovaskuläre Primär- und Sekundärprävention. Sind Sie hier schon auf dem neuesten Stand? Unsere Experten beleuchten, wo und warum das bisherige Procedere geändert werden soll und was in der Praxis sinnvoll ist. Holen Sie sich Ihr Update und 2 CME-Punkte beim MMW-Webinar am 24. April von 17.30 bis 19 Uhr. 
Erweiterte Suche
Anmelden
nach oben
Updates in Surgery
Erschienen in: Updates in Surgery 6/2021

05.01.2021 | Original Article

The use of an implemented infection prevention bundle reduces the incidence of surgical site infections after colorectal surgery: a retrospective single center analysis

verfasst von: Damiano Caputo, Alessandro Coppola, Tommaso Farolfi, Vincenzo La Vaccara, Silvia Angeletti, Chiara Cascone, Massimo Ciccozzi, Roberto Coppola

Erschienen in: Updates in Surgery | Ausgabe 6/2021

Einloggen, um Zugang zu erhalten

Abstract

Background

Surgical-site infections (SSIs) represent the most common complications after colorectal surgery (CS). Role of preoperative administration of oral antibiotic prophylaxis (OAP) and mechanical bowel preparation (MBP), alone or in combination, in the prevention of SSIs after CS is debated. Aim of this study was to assess the effect of the introduction of an Implemented Infection Prevention Bundle (IIPB) in preventing SSIs in CS.

Methods

A group of 251 patients (Group 1) who underwent CS receiving only preoperative intravenous antibiotic prophylaxis (IAP) was compared to a Group of 107 patients (Group 2) who also received the IIPB. The IIPB consisted of the combination of oral administrations of three doses of Rifaximin 400 mg and MBP the day before surgery and in the administration of a cleansing enema the day of the surgical procedure.

Results

At the univariate analysis, Group 2 showed significant lower rates of wound infection (WI) (2.8% vs. 9.9%; p = 0.021) and anastomotic leakage (AL) (2.8% vs. 14.7%; p = 0.001) with shorter hospital stay (5 vs. 6 days; p < 0.0001). The probability of postoperative AL was lower in Group 2; patients in this Group resulted protected from AL; a statistically significant Odds ratio of 0.16 (CI 0.05–0.55 p = 0.0034) was found. In diabetic patients, that were at higher risk of WI (OR 3.53, CI 1.49–8.35 p = 0.002), despite having any impact on anastomotic dehiscence, the use of IIPB significantly reduced the rate of WI (0% vs 28.1%; p = 0.01).

Conclusion

The use of an IIPB significantly reduces rates of SSIs and post-operative hospital stay after CS.
Literatur
1.
Horan TC, Gaynes RP, Martone WJ et al (1992) CDC definitions of noscomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 20(5):271–274PubMed
2.
Hennessey DB, Burke JP, Ni-Dhonochu T et al (2015) Risk factors for surgical site infection following colorectal resection: a multi-institutional study. Int J Colorectal Dis 31(2):267–271PubMed
3.
Kirkland KB, Briggs JP, Trivette SL et al (1999) The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 20(11):725–730PubMed
4.
De Lissovoy G, Fraeman K, Hutchins V et al (2009) Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 37(5):387–397PubMed
5.
Kobayashi M, Mohri Y, Inoue Y et al (2008) Continuous follow-up of surgical site infections for 30 days after colorectal surgery. World J Surg 32(6):1142–1146PubMed
6.
Smith RL, Bohl JK, McElearney ST et al (2004) Wound infection after elective colorectal resection. Ann Surg 239(5):599–605PubMedPubMedCentral
7.
Wick EC, Vogel JD, Church JM et al (2009) Surgical site infections in a “high outlier” institution: are colorectal surgeons to blame? Dis Colon Rectum 52(3):374–379PubMed
8.
Marchi M, Pan A, Gagliotti C et al (2014) The Italian national surgical site infection surveillance programme and its positive impact, 2009 to 2011. Euro Surveill 19(21):20815PubMed
9.
Zmora O, Wexner SD, Hajjar L et al (2003) Trends in preparation for colorectal surgery: survey of the members of the American Society of Colon and Rectal Surgeons. Am Surg 69:150–154PubMed
10.
Koullouros M, Khan N, Aly EH et al (2017) The role of oral antibiotics prophylaxis in prevention of surgical site infection in colorectal surgery. Int J Colorectal Dis 32(1):1–18PubMed
11.
Kobayashi M, Mohri Y, Tonouchi H et al (2007) Randomized clinical trial comparing intravenous anti-microbial prophylaxis alone with oral and intravenous antimicrobial prophylaxis for the prevention of a surgical site infection in colo-rectal cancer surgery. Surg Today 37(5):383–388PubMed
12.
Kiran RP, Murray AC, Chiuzan C et al (2015) Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery. Ann Surg 262:416–425PubMed
13.
Stellato TA, Danziger LH, Gordon N et al (1990) Antibiotics in elective colon surgery. A randomized trial of oral, systemic, and oral/systemic antibiotics for prophylaxis. Am Surg 56:251–254PubMed
14.
Espin-Basany E, Sanchez-Garcia JL, Lopez-Cano M et al (2005) Prospective, randomised study on antibiotic prophylaxis in colorectal surgery. Is it really necessary to use oral antibiotics? Int J Colorectal Dis Actions. 20(6):542–546
15.
DiPiro JT, Patrias JM, Townsend RJ et al (1985) Oral neomycin sulfate and erythromycin base before colon surgery: a comparison of serum and tissue concentrations. Pharmacotherapy 5:91–94PubMed
16.
McSorley ST, Steele CW, McMahon AJ (2018) Meta-analysis of oral antibiotics, in combination with preoperative intravenous antibiotics and mechanical bowel preparation the day before surgery, compared with intravenous antibiotics and mechanical bowel preparation alone to reduce surgical-site infections in elective colorectal surgery. BJS Open 2(4):185–194PubMedPubMedCentral
17.
Nina M, Robert S, Andrzej M, et al (2018) The use of rifaximin in pre-operative period of patients with tumors of the gastrointestinal tract—a retrospective study (2013–2016). Pol Przegl Chir.
18.
Scarpignato PR (2005) A poorly absorbed antibiotic: pharmacology and clinical potential. Chemotherapy
19.
Ohman KA, Wan L, Guthrie T et al (2017) Combination of oral antibiotics and mechanical bowel preparation reduces surgical site infection in colorectal surgery. J Am Coll Surg 225(4):465–471PubMed
20.
Klinger AL, Green H, Monlezun DJ et al (2019) The role of bowel preparation in colorectal surgery: results of the 2012–2015 ACS-NSQIP data. Ann Surg 269(4):671–677PubMed
21.
22.
Bucher P, Gervaz P, Soravia C et al (2005) Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery. Br J Surg 92:409–414PubMed
23.
Shapira Z, Feldman L, Lavy R et al (2010) Bowel preparation: comparing metabolic and electrolyte changes when using sodium phosphate/polyethylene glycol. Int J Surg 8:356–358PubMed
24.
Zheng L, Ming Y, Zhi-xun Z (2018) Current practice patterns of preoperative bowel preparation in colorectal surgery: a nation-wide survey by the Chinese Society of Colorectal Cancer. J Surg Onc
25.
Golub RW, Kerner BA, Wise WE Jr et al (1995) Colonoscopic bowel preparations–which one? A blinded, prospective, randomized trial. Dis Colon Rectum 38:594–599PubMed
26.
27.
28.
29.
Sica DA, Carl D, Zfass AM (2007) Acute phosphate nephropathy–an emerging issue. Am J Gastroenterol 102:1844–1847PubMed
30.
Regev A, Fraser G, Delpre G et al (1998) Comparison of two bowel preparations for colonoscopy: sodium picosulphate with magnesium citrate versus sulphate-free polyethylene glycol lavage solution. Am J Gastroenterol 93:1478–1482PubMed
31.
Kim YS, Hong CW, Kim BC, Han KS, Park JW, Choi HS, Sohn DK (2014) Randomized clinical trial comparing reduced-volume oral picosulfate and a prepackaged low-residue diet with 4-liter peg solution for bowel preparation. Dis Colon Rectum 57(4):522–528PubMed
32.
Caputo D, Angeletti S, Fiore S et al (2020) Delayed surgery after radio-chemotherapy for rectal adenocarcinoma is protective for anastomotic dehiscence: a single-center observational retrospective cohort study. Updates Surg 18:32306273
33.
Morikane K, Honda H, Yamagishi T et al (2014) Factors associated with surgical site infection in colorectal surgery: the Japan nosocomial infections surveillance. Infect Control Hos Epidemiol 35(6):660–666
34.
Chida K, Watanabe J, Suwa Y et al (2019) Risk factors for incisional surgical site infection after elective laparoscopic colorectal surgery. Ann Gastroenterol Surg 3(2):202–208PubMedPubMedCentral
35.
Degrate L, Garancini M, Misani M et al (2011) Right colon, left colon, and rectal surgeries are not similar for surgical site infection development: analysis of 277 elective and urgent colorectal resections. Int J Colorectal Dis 26(1):61–69PubMed
36.
Veyrie N, Ata T, Muscari F et al (2007) Anastomotic leakage after elective right versus left colectomy for cancer: prevalence and independent risk factors. J Am Col Surg 205(6):785–793
37.
McConnell YJ, Johnson PM, Porter GA et al (2018) Surgical site infections following colorectal surgery in patients with diabetes: association with postoperative hyperglycemia. J Gastrointest Surg 13(3):508–515
38.
Pastor C, Baek JH, Varma MG et al (2010) Validation of the risk index category as a predictor of surgical site infection in elective colorectal surgery. Dis Colon Rectum 53(5):721–727PubMed
39.
Konishi T, Watanabe T, Kishimoto J et al (2006) Elective colon and rectal surgery differ in risk factors for wound infection. Results of prospective surveillance. Ann Surg 244(5):758–763PubMedPubMedCentral
40.
Shiomi A, Ito M, Maeda K et al (2015) Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer: a propensity score matching analysis of 1,014 consecutive patients. J Am Coll Surg 220(2):186–194PubMed
41.
Ricciardi R, Roberts PL, Hall JF et al (2014) what is the effect of stoma construction on surgical site infection after colorectal surgery? J Gastrointest Surg 18(4):789–795PubMed
42.
Gomila A, Carratalà J, Biondo S et al (2018) Predictive factors for early- and late-onset surgical site infections in patients undergoing elective colorectal surgery. A multicentre, prospective, cohort study. J Hos Infect 99(1):24–30
43.
Olguín Joseau S, Bollati NP, Reimondez S et al (2018) Risk factors for surgical site infection in colon surgery in our population. Revista de La Facultad de Ciencias Médicas de Córdoba 75(4):229PubMed
44.
Lawson EH, Hall BL, Ko CY et al (2013) Risk factors for superficial vs deep/organ-space surgical site infections. JAMA Surg 148(9):849PubMed
45.
Kiran RP, El-Gazzaz GH, Vogel JD et al (2010) Laparoscopic approach significantly reduces surgical site infections after colorectal surgery: data from national surgical quality improvement program. J Am Coll Surg 211:232–238PubMed
46.
47.
Clayton TA, Baker D, Lindon JC et al (2009) Pharmacometabonomic identification of a significant host–microbiome metabolic interaction affecting human drug metabolism. Proc Natl Acad Sci USA 106:14728–14733PubMedPubMedCentral
48.
Zimmermann M, Zimmermann-Kogadeeva M, Wegmann R et al (2019) Mapping human microbiome drug metabolism by gut bacteria and their genes. Nature 570:462–467PubMedPubMedCentral
49.
Alexander JL, Wilson ID, Teare J et al (2017) Gut microbiota modulation of chemotherapy efficacy and toxicity. Nat Rev Gastroenterol Hepatol 14:356–365PubMed
50.
51.
Garfinkle R, Khalil JA, Morin N et al (2017) Is there a role for oral antibiotic preparation alone before colorectal surgery? ACS-NSQIP analysis by coarsened exact matching. Dis Colon Rectum 60(7):729–737PubMed
52.
Migaly J, Bafford AC, Francone TD et al (2019) The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the use of bowel preparation in elective colon and rectal surgery. Dis Colon Rectum 62:3–8PubMed
53.
Lei P, Ruan Y, Yang X et al (2020) Preoperative mechanical bowel preparation with oral antibiotics reduces surgical site infection after elective colorectal surgery for malignancies: results of a propensity matching analysis. World J Surg Oncol 18(1):35PubMedPubMedCentral
Metadaten
Titel
The use of an implemented infection prevention bundle reduces the incidence of surgical site infections after colorectal surgery: a retrospective single center analysis
verfasst von
Damiano Caputo
Alessandro Coppola
Tommaso Farolfi
Vincenzo La Vaccara
Silvia Angeletti
Chiara Cascone
Massimo Ciccozzi
Roberto Coppola
Publikationsdatum
05.01.2021
Verlag
Springer International Publishing
Erschienen in
Updates in Surgery / Ausgabe 6/2021
Print ISSN: 2038-131X
Elektronische ISSN: 2038-3312
DOI
https://doi.org/10.1007/s13304-020-00960-x

Weitere Artikel der Ausgabe 6/2021

Updates in Surgery 6/2021 Zur Ausgabe

Original Article

Can we routinely identify the external branch of the superior laryngeal nerves with neural monitoring?: a prospective report on 176 consecutive nerves at risk

Original Article

Jain point: an alternate laparoscopic non-umbilical first blind entry port to avoid vessel, viscera, adhesions and bowel (VVAB)

Letter to the Editor

Endoscopic treatment of an esophagomediastinal fistula arising from a perforated ulcer in Zenker’s diverticulum

Original Article

Implementation of enhanced recovery after surgery and its increasing compliance improved 5-year overall survival in resectable stage III colorectal cancer

Original Article

Transduodenal surgical ampullectomy: a procedure that requires a multidisciplinary approach

Original Article

Sexual dysfunction following surgery for rectal cancer: a single-institution experience

Neu im Fachgebiet Chirurgie

17.04.2024 | Postoperative nausea and vomiting | Nachrichten

Hochrisiko-Eingriffe für postoperative Übelkeit

16.04.2024 | HNO-Chirurgie | Nachrichten

HNO-Op. auch mit über 90?

16.04.2024 | Infektiologie | Nachrichten

Kein Abstrich bei chronischen Wunden ohne Entzündungszeichen!

10.04.2024 | Postoperative Schmerztherapie | Nachrichten

Chronische Schmerzen nach Op. oft mit neuropathischer Komponente
weitere anzeigen

Update Chirurgie

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

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom CME-Kurs
CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis 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 CME-Kurs
CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ 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 CME-Kurs
CME: 2 Punkte

Dr. med. Mihailo Andric
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.