Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Oct 5;18(1):507.
doi: 10.1186/s12879-018-3413-1.

Preoperative oral antibiotic prophylaxis reduces Pseudomonas aeruginosa surgical site infections after elective colorectal surgery: a multicenter prospective cohort study

A Gomila  1   2 , J Carratalà  3   4   5 , J M Badia  4   6   7 , D Camprubí  3   4 , M Piriz  4   8 , E Shaw  3   4 , V Diaz-Brito  4   9 , E Espejo  4   10 , C Nicolás  4   11 , M Brugués  4   12 , R Perez  4   13 , A Lérida  4   14 , A Castro  4   15 , S Biondo  4   16 , D Fraccalvieri  4   16 , E Limón  4   5 , F Gudiol  4   5 , M Pujol  3   4 ; VINCat Colon Surgery Group
Collaborators, Affiliations

Preoperative oral antibiotic prophylaxis reduces Pseudomonas aeruginosa surgical site infections after elective colorectal surgery: a multicenter prospective cohort study

A Gomila et al. BMC Infect Dis. .

Abstract

Background: Healthcare-associated infections caused by Pseudomonas aeruginosa are associated with poor outcomes. However, the role of P. aeruginosa in surgical site infections after colorectal surgery has not been evaluated. The aim of this study was to determine the predictive factors and outcomes of surgical site infections caused by P. aeruginosa after colorectal surgery, with special emphasis on the role of preoperative oral antibiotic prophylaxis.

Methods: We conducted an observational, multicenter, prospective cohort study of all patients undergoing elective colorectal surgery at 10 Spanish hospitals (2011-2014). A logistic regression model was used to identify predictive factors for P. aeruginosa surgical site infections.

Results: Out of 3701 patients, 669 (18.1%) developed surgical site infections, and 62 (9.3%) of these were due to P. aeruginosa. The following factors were found to differentiate between P. aeruginosa surgical site infections and those caused by other microorganisms: American Society of Anesthesiologists' score III-IV (67.7% vs 45.5%, p = 0.001, odds ratio (OR) 2.5, 95% confidence interval (95% CI) 1.44-4.39), National Nosocomial Infections Surveillance risk index 1-2 (74.2% vs 44.2%, p < 0.001, OR 3.6, 95% CI 2.01-6.56), duration of surgery ≥75thpercentile (61.3% vs 41.4%, p = 0.003, OR 2.2, 95% CI 1.31-3.83) and oral antibiotic prophylaxis (17.7% vs 33.6%, p = 0.01, OR 0.4, 95% CI 0.21-0.83). Patients with P. aeruginosa surgical site infections were administered antibiotic treatment for a longer duration (median 17 days [interquartile range (IQR) 10-24] vs 13d [IQR 8-20], p = 0.015, OR 1.1, 95% CI 1.00-1.12), had a higher treatment failure rate (30.6% vs 20.8%, p = 0.07, OR 1.7, 95% CI 0.96-2.99), and longer hospitalization (median 22 days [IQR 15-42] vs 19d [IQR 12-28], p = 0.02, OR 1.1, 95% CI 1.00-1.17) than those with surgical site infections due to other microorganisms. Independent predictive factors associated with P. aeruginosa surgical site infections were the National Nosocomial Infections Surveillance risk index 1-2 (OR 2.3, 95% CI 1.03-5.40) and the use of oral antibiotic prophylaxis (OR 0.4, 95% CI 0.23-0.90).

Conclusions: We observed that surgical site infections due to P. aeruginosa are associated with a higher National Nosocomial Infections Surveillance risk index, poor outcomes, and lack of preoperative oral antibiotic prophylaxis. These findings can aid in establishing specific preventive measures and appropriate empirical antibiotic treatment.

Keywords: Colorectal cancer; Colorectal surgery; Healthcare-associated infection; Spain; Surgical site infection.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Ethics Committee at Hospital Universitari de Bellvitge (reference: PR305/15). As this study analysed data that is part of the VINCat program registry, and no individual data is published as well as no intervention is performed to patients, no individual consent to participate was required by the Ethics Committee at our institution. This study conformed to the ORION guidelines for reporting cohort studies [36].

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Number of SSI caused by Pseudomonas aeruginosa per year. P. aeruginosa: Pseudomonas aeruginosa, SSI: surgical site infections. (%): percentage. This figure shows the percentage of surgical site infections caused by Pseudomonas aeruginosa after elective colorectal surgery in the whole cohort of patients
See this image and copyright information in PMC

References

    1. European Centre for Disease Prevention and Control. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals 2011–2012. https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publicat.... Accessed 8 Oct 2016.
    1. Anderson Deverick J., Podgorny Kelly, Berríos-Torres Sandra I., Bratzler Dale W., Dellinger E. Patchen, Greene Linda, Nyquist Ann-Christine, Saiman Lisa, Yokoe Deborah S., Maragakis Lisa L., Kaye Keith S. Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update. Infection Control & Hospital Epidemiology. 2014;35(06):605–627. doi: 10.1086/676022. - DOI - PMC - PubMed
    1. Petrosillo N, Drapeau CMJ, Nicastri E, Martini L, Ippolito G, Moro ML, et al. Surgical site infections in Italian hospitals: a prospective multicenter study. BMC infect Dis. 2008;8:34. doi: 10.1186/1471-2334-8-34. - DOI - PMC - PubMed
    1. Keenan JE, Speicher PJ, Thacker JKM, Walter M, Kuchibhatla M, Mantyh CR. The preventive surgical site infection bundle in colorectal surgery: an effective approach to surgical site infection reduction and health care cost savings. JAMA Surg. 2014;149:1045–1052. doi: 10.1001/jamasurg.2014.346. - DOI - PubMed
    1. Gellatly SL, Hancock RE. Pseudomonas aeruginosa: new insights into pathogenesis and host defenses. Pathog Dis. 2013;67(3):159–173. doi: 10.1111/2049-632X.12033. - DOI - PubMed

MeSH terms

Substances