Antibiotic Prophylaxis for Surgical Site Infection in General Surgery

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (30 November 2021) | Viewed by 26923

Special Issue Editors


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Emergency-Urgency Intercompany Department, Azienda Ospedaliero, Universitaria di Parma, 43126 Parma, Italy
Interests: intrabdominal infections
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Department of Surgery, Macerata Hospital, Via Santa Lucia, 2, Macerata, Italy
Interests: intrabdominal infections
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Surgical site infection (SSI) is associated with prolonged hospital stay, increased morbidity, mortality and sanitary costs, and reduced patient quality of life. Many hospitals have adopted guidelines of scientifically validated processes for the prevention of surgical site infections and sepsis. Antibiotic prophylaxis is among the most important and discussed issues in this field. Moreover, antibiotic prophylaxis carried out without appropriate indications can worsen the antibiotic resistance burden. A review of the best available evidence of these measures in general surgery will be presented. It will comprise 12 articles for different general surgery subspecialist areas: (1) antibiotic prophylaxis: torment and ecstasy; (2) upper gastrointestinal; (3) lower gastrointestinal; (4) hepatobiliary; (5) pancreatic; (6) endocrine; (7) breast; (8) abdominal wall; (9) acute care surgery; (10) oncological treatments and HIPEC; (11) vascular surgery; and (12) thoracic surgery.

Prof. Dr. Fausto Catena
Dr. Massimo Sartell
Guest Editors

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Keywords

  • antibiotic prophylaxis
  • general surgery
  • surgical site infections

Published Papers (9 papers)

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Research

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6 pages, 218 KiB  
Communication
Antibiotic Prophylaxis for Surgical Site Infection in General Surgery: Oncological Treatments and HIPEC
by Carlo Vallicelli, Federico Coccolini, Massimo Sartelli, Luca Ansaloni, Simona Bui and Fausto Catena
Antibiotics 2022, 11(1), 43; https://doi.org/10.3390/antibiotics11010043 - 30 Dec 2021
Cited by 1 | Viewed by 1417
Abstract
The procedure of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a combined surgical and oncological treatment for peritoneal carcinomatosis of various origins. Antibiotic prophylaxis is usually center-related and should be discussed together with the infectious disease specialist, taking into account the [...] Read more.
The procedure of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a combined surgical and oncological treatment for peritoneal carcinomatosis of various origins. Antibiotic prophylaxis is usually center-related and should be discussed together with the infectious disease specialist, taking into account the advanced oncologic condition of the patient, the complexity of surgery—often requiring multiorgan resections—and the risk of post-HIPEC neutropenia. The incidence of surgical site infection (SSI) after CRS and HIPEC ranges between 11 and 46%. These patients are also at high risk of postoperative abdominal infections and septic complications, and a bacterial translocation during HIPEC has been hypothesized. Many authors have proposed aggressive screening protocols and a high intra and postoperative alert, in order to minimize and promptly identify all possible infectious complications following CRS and HIPEC. Full article
(This article belongs to the Special Issue Antibiotic Prophylaxis for Surgical Site Infection in General Surgery)
7 pages, 409 KiB  
Article
Bacterial Epidemiology of Surgical Site Infections after Open Fractures of the Lower Limb: A Retrospective Cohort Study
by Tracie Joyner Youbong, Astrid De Pontfarcy, Maxence Rouyer, Alessio Strazzula, Catherine Chakvetadze, Clara Flateau, Samir Sayegh, Coralie Noel, Aurélia Pitsch, Abdelmalek Abbadi and Sylvain Diamantis
Antibiotics 2021, 10(12), 1513; https://doi.org/10.3390/antibiotics10121513 - 10 Dec 2021
Cited by 4 | Viewed by 2431
Abstract
Open lower limb fractures are common injuries, and the occurrence of infectious complications after open fractures is a usual problem. The rate of surgical site infections (SSIs) and the nature and resistance of the germs responsible for SSIs remain poorly described. Our aim [...] Read more.
Open lower limb fractures are common injuries, and the occurrence of infectious complications after open fractures is a usual problem. The rate of surgical site infections (SSIs) and the nature and resistance of the germs responsible for SSIs remain poorly described. Our aim was to describe the bacterial epidemiology of SSIs after surgical management of an open lower limb fracture. We conducted a retrospective monocentric cohort study from 1 January 2012 to 31 December 2020 based on the analysis of inpatient records in a non-university hospital of Ile de France region. All patients who underwent surgery for an open lower limb fracture were included. A total of 149 patients were included. In our population, 19 (12.7%) patients developed an SSI. Of these 19 patients, the sample was polymicrobial in 9 (47.4%) patients. In 9 (45%) cases, the samples identified a group 3 enterobacteria, Enterobacter cloacae being the main one in 7 (36.9%) cases. Staphylococci were identified in 11 patients, with Staphylococcus aureus in 9 (47.4%). All Staphylococcus aureus were susceptible to methicillin, and all enterobacteria were susceptible to C3G. Among all SSI, 10 (58.8%) contained at least one germ resistant to amoxicillin/clavulanic acid (AMC). The SSIs rate was 12.7%. The main pathogens identified were Enterobacter cloacae and Staphylococcus aureus. The presence of early SSI caused by group 3 Enterobacteriaceae renders current antibiotic prophylaxis protocols inadequate with AMC in half the cases. Full article
(This article belongs to the Special Issue Antibiotic Prophylaxis for Surgical Site Infection in General Surgery)
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Review

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16 pages, 440 KiB  
Review
Groin Surgical Site Infection in Vascular Surgery: Systemic Review on Peri-Operative Antibiotic Prophylaxis
by Bruno Amato, Rita Compagna, Salvatore De Vivo, Aldo Rocca, Francesca Carbone, Maurizio Gentile, Roberto Cirocchi, Francesco Squizzato, Andrea Spertino and Piero Battocchio
Antibiotics 2022, 11(2), 134; https://doi.org/10.3390/antibiotics11020134 - 20 Jan 2022
Cited by 11 | Viewed by 3762
Abstract
Objectives: Surgical site infections (SSIs) in lower extremity vascular surgeries, post-groin incision, are not only common complications and significant contributors to patient mortality and morbidity, but also major financial burdens on healthcare systems and patients. In spite of recent advances in pre- and [...] Read more.
Objectives: Surgical site infections (SSIs) in lower extremity vascular surgeries, post-groin incision, are not only common complications and significant contributors to patient mortality and morbidity, but also major financial burdens on healthcare systems and patients. In spite of recent advances in pre- and post-operative care, SSI rates in the vascular surgery field remain significant. However, compliant antibiotic therapy can successfully reduce the SSI incidence pre- and post-surgery. Methods: In October 2021, we conducted a systematic literature review using OVID, PubMed, and EMBASE databases, centered on studies published between January 1980 and December 2020. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta Analyses checklist. Inclusion/exclusion criteria have been carefully selected and reported in the text. For analyses, we calculated 95% confidence intervals (CI) and weighted odds ratios to amalgamate control and study groups in publications. We applied The Cochrane Collaboration tool to assess bias risk in selected studies. Results: In total, 592 articles were identified. After the removal of duplicates and excluded studies, 36 full-texts were included for review. Conclusions: The review confirmed that antibiotic therapy, administered according to all peri-operative protocols described, is useful in reducing groin SSI rate in vascular surgery. Full article
(This article belongs to the Special Issue Antibiotic Prophylaxis for Surgical Site Infection in General Surgery)
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Other

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15 pages, 1694 KiB  
Systematic Review
Effect of Antibiotic Prophylaxis on Surgical Site Infection in Thyroid and Parathyroid Surgery: A Systematic Review and Meta-Analysis
by Andrea Polistena, Francesco Paolo Prete, Stefano Avenia, Giuseppe Cavallaro, Giovanna Di Meo, Alessandro Pasculli, Fabio Rondelli, Alessandro Sanguinetti, Lucia Ilaria Sgaramella, Nicola Avenia, Mario Testini and Angela Gurrado
Antibiotics 2022, 11(3), 290; https://doi.org/10.3390/antibiotics11030290 - 22 Feb 2022
Cited by 5 | Viewed by 2557
Abstract
Thyroid and parathyroid surgery are considered clean procedures, with an incidence of surgical site infection (SSI) after thyroidectomy ranging from 0.09% to 2.9%. International guidelines do not recommend routine antibiotic prophylaxis (AP), while AP seems to be employed commonly in clinical practice. The [...] Read more.
Thyroid and parathyroid surgery are considered clean procedures, with an incidence of surgical site infection (SSI) after thyroidectomy ranging from 0.09% to 2.9%. International guidelines do not recommend routine antibiotic prophylaxis (AP), while AP seems to be employed commonly in clinical practice. The purpose of this systematic review is analyzing whether the postoperative SSI rate in thyroid and parathyroid surgery is altered by the practice of AP. We searched Pubmed, Scopus, the Cochrane Library, and Web of Science (WOS) for studies comparing AP to no preoperative antibiotics up to October 2021. Data on the SSI rate was evaluated and summarized as relative risks (RR) with 95% confidence intervals (95% CI). Risk of bias of studies were assessed with standard methods. Nine studies (4 RCTs and 5 nRCTs), including 8710 participants, were eligible for quantitative analysis. A meta-analysis showed that the SSI rate was not significantly different between AP and no preoperative antibiotics (SSI rate: 0.6% in AP vs. 2.4% in control group; RR 0.69, 0.43–1.10 95% CI, p = 0.13, I2 = 0%). A sensitivity analysis and subgroup analysis on RCTs were consistent with the main findings. Evidence of low quality supports that AP in thyroid and parathyroid surgery produce similar SSI rates as to the absence of perioperative antibiotics. Full article
(This article belongs to the Special Issue Antibiotic Prophylaxis for Surgical Site Infection in General Surgery)
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15 pages, 1238 KiB  
Systematic Review
Antimicrobial Prophylaxis Reduces the Rate of Surgical Site Infection in Upper Gastrointestinal Surgery: A Systematic Review
by Luigi Marano, Ludovico Carbone, Gianmario Edoardo Poto, Natale Calomino, Alessandro Neri, Riccardo Piagnerelli, Andrea Fontani, Luigi Verre, Vinno Savelli, Franco Roviello and Daniele Marrelli
Antibiotics 2022, 11(2), 230; https://doi.org/10.3390/antibiotics11020230 - 10 Feb 2022
Cited by 11 | Viewed by 2985
Abstract
Surgical site infection occurs with high frequency in gastrointestinal surgery, contributing to the high incidence of morbidity and mortality. The accepted practice worldwide for the prevention of surgical site infection is providing single- or multiple-dose antimicrobial prophylaxis. However, most suitable antibiotic and optimal [...] Read more.
Surgical site infection occurs with high frequency in gastrointestinal surgery, contributing to the high incidence of morbidity and mortality. The accepted practice worldwide for the prevention of surgical site infection is providing single- or multiple-dose antimicrobial prophylaxis. However, most suitable antibiotic and optimal duration of prophylaxis are still debated. The aim of the systematic review is to assess the efficacy of antimicrobial prophylaxis in controlling surgical site infection rate following esophagogastric surgery. PubMed and Cochrane databases were systematically searched until 31 October 2021, for randomized controlled trials comparing different antimicrobial regimens in prevention surgical site infections. Risk of bias of studies was assessed with standard methods. Overall, eight studies concerning gastric surgery and one study about esophageal surgery met inclusion criteria. No significant differences were detected between single- and multiple-dose antibiotic prophylaxis. Most trials assessed the performance of cephalosporins or inhibitor of bacterial beta-lactamase. Antimicrobial prophylaxis (AMP) is effective in reducing the incidence of surgical site infection. Multiple-dose antimicrobial prophylaxis is not recommended for patients undergoing gastric surgery. Further randomized controlled trials are needed to determine the efficacy and safety of antimicrobial prophylaxis in esophageal cancer patients. Full article
(This article belongs to the Special Issue Antibiotic Prophylaxis for Surgical Site Infection in General Surgery)
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12 pages, 285 KiB  
Systematic Review
Antibiotic Prophylaxis for Hepato-Biliopancreatic Surgery—A Systematic Review
by Francesca Steccanella, Paolo Amoretti, Maria Rachele Barbieri, Fabio Bellomo and Alessandro Puzziello
Antibiotics 2022, 11(2), 194; https://doi.org/10.3390/antibiotics11020194 - 01 Feb 2022
Cited by 4 | Viewed by 2779
Abstract
Background: Surgical site infections (SSIs) are among the most important determinants of morbidity after HBP surgery. Their frequency after HPB surgery is variable, from 1–2% after elective cholecystectomy to 25% after PD. Methods: A systematic review was performed to assess the role of [...] Read more.
Background: Surgical site infections (SSIs) are among the most important determinants of morbidity after HBP surgery. Their frequency after HPB surgery is variable, from 1–2% after elective cholecystectomy to 25% after PD. Methods: A systematic review was performed to assess the role of antimicrobial prophylaxis (AP) in HPB elective surgery. Articles published between 2015 and 2021 were obtained; those before 2015 were not included because they antedate the WHO guidelines on SSI prevention. We conducted three different research methods for liver resection, elective cholecystectomy and pancreatic and biliary surgery regarding patients requiring preoperative biliary drainage. Results: Hepatic surgery, improvement in surgical technique and perioperative management lead to a very low SSI. One preoperative 2 g cefazolin dose may be adequate for surgical prophylaxis. From preoperative biliary drainage, we can derive that patients’ homeostasis rather than AP plays a paramount role in reducing postoperative morbidity. The time from biliary drainage could be an essential element in decision making for surgical prophylaxis. In the case of low-risk cholecystectomy, it is not easy to draw definitive conclusions about the effect of AP. Data from the literature are inconsistent, and some risk factors cannot be predicted before surgery. Conclusion: in our opinion, a strict preoperative cefazolin dose strategy can be reasonable in HBP surgery until a large-scale, multicentric RCT brings definitive conclusions. Full article
(This article belongs to the Special Issue Antibiotic Prophylaxis for Surgical Site Infection in General Surgery)
20 pages, 605 KiB  
Systematic Review
Antibiotic Prophylaxis in Torso, Maxillofacial, and Skin Traumatic Lesions: A Systematic Review of Recent Evidence
by Enrico Cicuttin, Massimo Sartelli, Emanuele Scozzafava, Dario Tartaglia, Camilla Cremonini, Bruno Brevi, Niccolò Ramacciotti, Serena Musetti, Silvia Strambi, Mauro Podda, Fausto Catena, Massimo Chiarugi and Federico Coccolini
Antibiotics 2022, 11(2), 139; https://doi.org/10.3390/antibiotics11020139 - 21 Jan 2022
Cited by 3 | Viewed by 3913
Abstract
Use of antibiotic prophylaxis (AP) in trauma patients is a common practice. However, considering the increasing rates of antibiotic resistance, AP use should be questioned and limited only to specific cases. We performed a systematic review of recent literature (from year 2000), aiming [...] Read more.
Use of antibiotic prophylaxis (AP) in trauma patients is a common practice. However, considering the increasing rates of antibiotic resistance, AP use should be questioned and limited only to specific cases. We performed a systematic review of recent literature (from year 2000), aiming to summarize the state of the art on efficacy and appropriateness of AP in patients with traumatic injuries of torso, maxillofacial complex and skin (including burns). Twenty-six articles were selected. In thoracic trauma, AP could be useful in reducing infective complications in tube thoracostomy for penetrating trauma. In maxillo-facial trauma, AP could find a role in the peri-operative trauma setting in the case of a graft or prosthetic implant. In abdominal trauma, there is a lack of consensus on the definition of contamination, infection, antibiotic therapy, and prophylaxis. In burned patients, routine AP is not suggested. In the case of human bites to the extremities, AP could find an indication. Future studies should focus on the subcategories of patients at higher risk of infection, identifying those who would benefit from AP. Attention to antimicrobial stewardship and guidelines focused on AP in trauma are required, to reduce antibiotic abuse, and increase quality research. Full article
(This article belongs to the Special Issue Antibiotic Prophylaxis for Surgical Site Infection in General Surgery)
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18 pages, 1761 KiB  
Systematic Review
Oral and Parenteral vs. Parenteral Antibiotic Prophylaxis for Patients Undergoing Laparoscopic Colorectal Resection: An Intervention Review with Meta-Analysis
by Giuseppe Sangiorgio, Marco Vacante, Francesco Basile and Antonio Biondi
Antibiotics 2022, 11(1), 21; https://doi.org/10.3390/antibiotics11010021 - 24 Dec 2021
Cited by 6 | Viewed by 3006
Abstract
This study aims to systematically assess the efficacy of parenteral and oral antibiotic prophylaxis compared to parenteral-only prophylaxis for the prevention of surgical site infection (SSI) in patients undergoing laparoscopic surgery for colorectal cancer resection. Published and unpublished randomized clinical trials comparing the [...] Read more.
This study aims to systematically assess the efficacy of parenteral and oral antibiotic prophylaxis compared to parenteral-only prophylaxis for the prevention of surgical site infection (SSI) in patients undergoing laparoscopic surgery for colorectal cancer resection. Published and unpublished randomized clinical trials comparing the use of oral and parenteral prophylactic antibiotics vs. parenteral-only antibiotics in patients undergoing laparoscopic colorectal surgery were collected searching electronic databases (MEDLINE, CENTRAL, EMBASE, SCIENCE CITATION INDEX EXPANDED) without limits of date, language, or any other search filter. The outcomes included SSIs and other infectious and noninfectious postoperative complications. Risk of bias was assessed using the Cochrane revised tool for assessing risk of bias in randomized trials (RoB 2). A total of six studies involving 2252 patients were finally included, with 1126 cases in the oral and parenteral group and 1126 cases in the parenteral-only group. Meta-analysis results showed a statistically significant reduction of SSIs (OR 0.54, 95% CI 0.40 to 0.72; p < 0.0001) and anastomotic leakage (OR 0.55, 95% CI 0.33 to 0.91; p = 0.02) in the group of patients receiving oral antibiotics in addition to intravenous (IV) antibiotics compared to IV alone. Our meta-analysis shows that a combination of oral antibiotics and intravenous antibiotics significantly lowers the incidence of SSI compared with intravenous antibiotics alone. Full article
(This article belongs to the Special Issue Antibiotic Prophylaxis for Surgical Site Infection in General Surgery)
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6 pages, 196 KiB  
Perspective
The “Torment” of Surgical Antibiotic Prophylaxis among Surgeons
by Massimo Sartelli, Federico Coccolini, Angeloantonio Carrieri, Francesco M. Labricciosa, Enrico Cicuttin and Fausto Catena
Antibiotics 2021, 10(11), 1357; https://doi.org/10.3390/antibiotics10111357 - 06 Nov 2021
Cited by 5 | Viewed by 2287
Abstract
Surgical antibiotic prophylaxis (SAP) is one of the peri-operative measures for preventing surgical site infections (SSIs). Its goal is to counteract the proliferation of bacteria in the surgical site during intervention in order to reduce the risk of SSIs. SAP should be administered [...] Read more.
Surgical antibiotic prophylaxis (SAP) is one of the peri-operative measures for preventing surgical site infections (SSIs). Its goal is to counteract the proliferation of bacteria in the surgical site during intervention in order to reduce the risk of SSIs. SAP should be administered for surgical interventions where the benefit expected (prevention of SSIs) is higher compared to the risk (serious side effects, such as acute kidney injury, Clostridioides difficile infection, and the spread of antimicrobial resistance). In prescribing SAP, surgeons should have both the awareness necessary “to handle antibiotics with care”, and the knowledge required to use them appropriately. Full article
(This article belongs to the Special Issue Antibiotic Prophylaxis for Surgical Site Infection in General Surgery)
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