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Is Previous Postoperative Infection an Independent Risk Factor for Postoperative Infection after Second Unrelated
Susan L Feldt1, Robert Keskey2, Pranav Krishnan1
1From the Pritzker School of Medicine, University of Chicago, Chicago, IL (Feldt, Krishnan).
Background:
Infections after abdominal surgery remain a significant problem. Although preoperative antibiotic prophylaxis is a primary strategy used to reduce postoperative infections, it is typically prescribed based on standardized protocols, without attention to previous infection or antibiotic history. Patients with a previous infection after surgery may be at higher risk for infectious complications after subsequent operations owing to antibiotic resistance. We hypothesized that a previous postoperative infection is a significant risk factor for the development of infection after a second unrelated surgery.
Study Design:
We performed a retrospective study of patients who had undergone 2 unrelated abdominal operations at a tertiary care center from 2012 to 2018. Clinical variables and microbiological culture results were abstracted. Univariate and multivariable regression models were constructed.
Results:
Of 758 patients, 15.0% (n = 114) developed an infection after the first operation. After the second operation, 22.8% (n = 26) of those with a previous infection developed another infection, whereas the incidence of an infection after the second operation was only 9.5% (n = 61) in patients who did not develop an infection after the first operation. Multivariable analysis demonstrated that previous infection (odds ratio 2.49, 95% CI 1.46 to 4.25) was associated with future infection risk. Microbiological analysis found that infections after the second surgery were significantly more likely to be antibiotic resistant than infections after the first surgery (82.3% vs 64.1%; p = 0.036). Strikingly, 49% of infections after the second surgery were resistant to the antibiotic prophylaxis given at the time of incision.
Conclusions:
Previous postoperative infection is an independent risk factor for a subsequent postoperative infection and is associated with resistance to standard prophylaxis. Individualization of antibiotic prophylaxis in patients with a previous postoperative infection is warranted.
Insights
A prior surgical site infection increases the risk of developing another infection after a second operation. These subsequent infections are more likely to be antibiotic-resistant, necessitating personalized antibiotic prophylaxis strategies.
Area of Science:
- Surgical site infections
- Antibiotic resistance
- Public health
Background:
- Postoperative infections are a significant challenge in abdominal surgery.
- Current antibiotic prophylaxis protocols are standardized and do not account for individual patient history.
- Previous infections may increase risk due to antibiotic resistance in subsequent operations.
Purpose of the Study:
- To investigate if a previous postoperative infection is a risk factor for developing infection after a second unrelated surgery.
- To assess the impact of prior infection on the likelihood and characteristics of subsequent infections.
Main Methods:
- Retrospective study of patients undergoing two unrelated abdominal operations (2012-2018).
- Analysis of clinical variables and microbiological culture results.
- Construction of univariate and multivariable regression models.
Main Results:
- Patients with a prior infection had a 2.49 times higher risk of infection after a second surgery.
- Infections after the second surgery were more likely to be antibiotic-resistant (82.3% vs 64.1%).
- Nearly half of second-surgery infections were resistant to the prophylactic antibiotic used.
Conclusions:
- Previous postoperative infection is an independent risk factor for subsequent infections.
- Prior infection is associated with increased antibiotic resistance, challenging standard prophylaxis.
- Individualizing antibiotic prophylaxis for patients with prior infections is recommended.
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