Dataset Information

A diagnostic algorithm for the surveillance of deep surgical site infections after colorectal surgery.

ABSTRACT:

Objective

Surveillance of surgical site infections (SSIs) is important for infection control and is usually performed through retrospective manual chart review. The aim of this study was to develop an algorithm for the surveillance of deep SSIs based on clinical variables to enhance efficiency of surveillance.

Design

Retrospective cohort study (2012-2015).

Setting

A Dutch teaching hospital.

Participants

We included all consecutive patients who underwent colorectal surgery excluding those with contaminated wounds at the time of surgery. All patients were evaluated for deep SSIs through manual chart review, using the Centers for Disease Control and Prevention (CDC) criteria as the reference standard.

Analysis

We used logistic regression modeling to identify predictors that contributed to the estimation of diagnostic probability. Bootstrapping was applied to increase generalizability, followed by assessment of statistical performance and clinical implications.

Results

In total, 1,606 patients were included, of whom 129 (8.0%) acquired a deep SSI. The final model included postoperative length of stay, wound class, readmission, reoperation, and 30-day mortality. The model achieved 68.7% specificity and 98.5% sensitivity and an area under the receiver operator characteristic (ROC) curve (AUC) of 0.950 (95% CI, 0.932-0.969). Positive and negative predictive values were 21.5% and 99.8%, respectively. Applying the algorithm resulted in a 63.4% reduction in the number of records requiring full manual review (from 1,606 to 590).

Conclusions

This 5-parameter model identified 98.5% of patients with a deep SSI. The model can be used to develop semiautomatic surveillance of deep SSIs after colorectal surgery, which may further improve efficiency and quality of SSI surveillance.

SUBMITTER: Mulder T

PROVIDER: S-EPMC6536899 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Publications

A diagnostic algorithm for the surveillance of deep surgical site infections after colorectal surgery.

Mulder Tessa T Kluytmans-van den Bergh Marjolein F Q MFQ van Mourik Maaike S M MSM Romme Jannie J Crolla Rogier M P H RMPH Bonten Marc J M MJM Kluytmans Jan A J W JAJW

Infection control and hospital epidemiology 20190314 5

<h4>Objective</h4>Surveillance of surgical site infections (SSIs) is important for infection control and is usually performed through retrospective manual chart review. The aim of this study was to develop an algorithm for the surveillance of deep SSIs based on clinical variables to enhance efficiency of surveillance.<h4>Design</h4>Retrospective cohort study (2012-2015).<h4>Setting</h4>A Dutch teaching hospital.<h4>Participants</h4>We included all consecutive patients who underwent colorectal su ...[more]

PMID: 30868984

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Project description:ObjectiveWe conducted this meta-analysis to explore the risk factors and incidence of deep surgical site infections (DSSIs) after orthopaedic trauma surgery.MethodsA systematic search was conducted across various databases, including MEDLINE, Embase, Cochrane Library, and Web of Science, for studies examining risk factors associated with DSSIs after bone trauma procedures. The search concluded on September 1, 2024. Data analysis was performed using Stata 15.0.ResultsAmong 2,722 publications screened, 16 studies that met the eligibility criteria were included in the analysis, involving a total of 22,318 patients, of whom 894 experienced DSSIs. The meta-analysis revealed a combined incidence of deep infections after orthopedic trauma surgery at [ES = 6.7%, 95% CI (5.1%-8.2%)]. Risk factors identified included male gender [OR = 1.99, 95% CI (1.39, 2.86), p < 0.0001], current smoking status [OR = 2.60, 95% CI (1.85, 3.65), p < 0.0001], open injuries [OR = 3.17, 95% CI (1.72, 5.85), p < 0.0001], a BMI greater than 26.0 kg/m2 [OR = 1.95, 95% CI (1.24, 3.07), p = 0.004], wound class ≥ 2 [OR = 2.40, 95% CI (1.56, 3.70), p < 0.0001], and a surgery duration of 60 min or more [OR = 2.41, 95% CI (1.63, 3.55), p < 0.0001]. These factors significantly contribute to the risk of developing DSSIs post-surgery. However, age did not exhibit a significant difference.ConclusionThis study identifies key risk factors for DSSI following orthopedic trauma surgery, addressing a gap in the existing literature and offering some insights for clinical decision-making. To mitigate the risk of DSSI, clinical practice should encourage patients to lose weight and quit smoking prior to surgery, optimize surgical procedures, and improve wound management strategies. Future research should aim to standardize follow-up durations and further refine the classification of risk factors, in order to validate and expand on the conclusions of this study.

Project description:BackgroundThis work aims at providing practical recommendations for implementing automated surveillance (AS) of surgical site infections (SSI) in hospitals and surveillance networks. It also provides an overview of the steps, choices, and obstacles that need to be taken into consideration when implementing such surveillance. Hands-on experience with existing automated surveillance systems of SSI (AS SSI systems) in Denmark, France, the Netherlands and Spain is described regarding trend monitoring, benchmarking, quality control, and research for surveillance purposes.MethodsBetween April and October 2023, specific aspects/options of various surveillance purposes for AS SSI were identified during regular meetings of the SSI working group in the PRAISE (Providing a Roadmap for Automated Infection Surveillance in Europe) network. Expert discussions provided the basis for this perspective article.ResultsDecisions for implementation of AS SSI systems highly depend on the purpose of the surveillance. AS SSI systems presented here differ according to study population, setting, central or local implementation; the level of automation, design, and the data sources used. However, similarities were found for the rationales of automation, design principles and obstacles that were identified. There was consensus among all the experts that shortcomings in interoperability of databases, limited time, a want of commitment on the part of stakeholders, and a shortage of resources for information technology (IT) specialists represent the main obstacles for implementing AS SSI. To overcome obstacles, various solutions were reported, including training in the development of AS systems and the interpretation of AS SSI results, early consultation of end-users, and regular exchanges between management levels, IT departments, infection prevention and control (IPC) teams, and clinicians.ConclusionClarity on the intended application (e.g. purpose of surveillance) and information on the availability of electronic and structured data are crucial first steps necessary for guiding decisions on the design of AS systems. Adequate resources for IT specialists and regular communication between management, IT departments, IPC teams, and clinicians were identified as essential for successful implementation. This perspective article may be helpful for a wider implementation of more homogeneous AS SSI systems in Europe.

Project description:BackgroundPreoperative treatment with oral neomycin combined with erythromycin or metronidazole is recommended to decrease the risk of surgical site infections (SSIs) in elective colorectal surgery. However, oral neomycin is not commercially available in Canada, and therefore it is not routinely used. Fluoroquinolones are widely available and have excellent activity against aerobic Gram-negative bacteria. The aim of this systematic review was to identify, critically appraise and summarize the evidence on the efficacy and safety of preoperative use of oral fluoroquinolone antibiotics for the prevention of SSIs in adult patients undergoing elective colorectal resection.MethodsFollowing Cochrane guidelines, we included English-language randomized controlled trials (RCTs) comparing oral fluoroquinolones plus routine preoperative intravenous antibiotics against intravenous antibiotics alone from MEDLINE (Ovid), Embase (Ovid), the Cochrane Central Register of Controlled Trials( Ovid) and ClinicalTrials.gov.ResultsWe included 3 RCTs (1136 patients). Risk of bias was uncertain in 2 trials and high in 1 trial. Preoperative oral fluoroquinolones led to significantly decreased total SSIs (risk ratio [RR] 0.43, 95% confidence interval [CI] 0.32-0.57, I 2 = 0%), superficial incisional (RR 0.38, 95% CI 0.22-0.68, I 2 = 32%), deep incisional (RR 0.19, 95% CI 0.06-0.65, I 2 = 0%) and organ/space SSIs (RR 0.34, 95% CI 0.12-0.90, I 2 = 33%). There was also a significant reduction in anastomotic leaks (RR 0.22, 95% CI 0.06-0.87, I 2 = 0%). No antibiotic-related adverse events were reported.ConclusionThis review suggests that preoperative oral fluoroquinolones with intravenous antibiotics are superior to intravenous antibiotics alone for preventing SSIs after colorectal surgery. If neomycin is unavailable, oral fluoroquinolones should be considered as a reasonable alternative. Future trials are required to further compare the relative efficacy of oral antibiotic regimens.

Dataset Information

A diagnostic algorithm for the surveillance of deep surgical site infections after colorectal surgery.

Objective

Design

Setting

Participants

Analysis

Results

Conclusions

Publications

A diagnostic algorithm for the surveillance of deep surgical site infections after colorectal surgery.

Similar Datasets

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