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


Wounds. 2018;30(4):108-113. 

In This Article


Albeit a small-scale observational study, the substantial burden of SSI after colorectal surgery secondary to ESBL pathogens in the treating tertiary center raises concern that action must be taken. Enterobacteriaceae are the most common pathogen responsible for SSIs in colorectal surgery[16] and ESBL prevalence is rapidly growing amongst them.[20] It is imperative that clinicians improve the current practice and actions, such as adding an ESBL screening program for patients having colorectal surgery, to help address part of the problem. Despite asymptomatic colonization being a risk factor for infection, the literature remains torn regarding the cost effectiveness of routine ESBL screening. Current practice advocates screening for high-risk populations only, such as critically ill/intensive care unit patients, patients from high-risk countries, those experiencing prolonged hospitalization, and those for whom medical devices are present.[28] Extending routine ESBL screening to include patients undergoing colorectal surgery as an additional high-risk population may be integral to the prevention of SSI in colorectal surgery. Positive screening and colonization per se might not be indications for active treatment but can provide more accurate guidance on the limited choices for antimicrobial prophylaxis.

As outlined in the guidelines for antimicrobial prescribing, it is crucial that criteria in the choice of correct antibiotic prophylaxis are respected, on the basis of the microorganisms expected in the operative site and with consideration to local and disease-specific antimicrobial sensitivities.[10,29] Inability to cover for the likely pathogens in the operative site results in failure to recognize and appropriately treat a postoperative complication and the associated implications in morbidity and economic cost.

Extended-spectrum β-lactamase-producing pathogens were accountable for a substantial burden of disease on SSIs after colorectal surgery. The high prevalence of ESBL in the authors' hospital cannot be ignored and is of great clinical concern. The authors recommend routine screening of ESBL in patients undergoing colorectal surgery and optimization of antibiotic prophylaxis based on an established protocol. The cost effectiveness of a dedicated screening program requires further study.