Characteristics of Surgical Site Infection Following Colorectal Surgery in a Tertiary Center

Extended-Spectrum beta-Lactamase-Producing Bacteria Culprits in Disease

Eliana Kalakouti, MD; Constantinos Simillis, MD; Gianluca Pellino, MD; Nabeela Mughal, MD; Oliver Warren, MD; Sarah Mills, MD; Emile Tan, MD; Christos Kontovounisios, MD; Paris P. Tekkis, MD

Disclosures

Wounds. 2018;30(4):108-113. 

In This Article

Materials and Methods

Study Design and Inclusion Criteria

Patients were identified from a prospectively maintained database of the colorectal department in Chelsea and Westminster Hospital, London, United Kingdom. Consecutive patients undergoing bowel resection operation (ie, laparoscopy, laparotomy, or laparoscopic-assisted colectomy) for benign or malignant colorectal disease from March 2015 to March 2016 were included. All operations were performed by a specialist colorectal team on a case-by-case basis.

Definitions

A SSI was defined in agreement with the standard set of clinical criteria for infection, outlined by the US Centers for Disease Control and Prevention (CDC)[15] as infection involving the skin or subcutaneous tissue (superficial SSI) or fascial and muscle layers (deep SSI) of the surgical incision sites. It should occur within 30 days of the operation and demonstrate at least 1 of the following:

  • Purulent discharge;

  • Organisms isolated in aseptically obtained wound cultures;

  • At least 1 of the 4 cardinal signs of infection: erythema, heat, pain, and swelling of incision deliberately opened by surgeon;

  • Development of an abscess; or

  • Diagnosis of a SSI by attending surgeon.

Sample

The data on the total number of operations that met the inclusion criteria (n = 123) and the number of operations that were complicated by SSI (n = 26) were derived from the monthly Mortality and Morbidity data for colorectal surgery.

Data Sources

Patient demographics, mode of admission to hospital (elective or emergency), operation details, length of stay, microbiology results, and antibiotic regime were determined by accessing case notes including the operation note, discharge summaries, and electronic patient records. Key individuals contacted included the Tissue Viability Clinical Specialist Nurse (TVN), Microbiology Department, Lead Antimicrobial Pharmacist, and Theatre Coordinator. The data collection proforma used is shown in Table 1.

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