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The Role of the Gut Microbiome on the Development of Surgical Site Infections

Monika A Krezalek1, John C Alverdy2

  • 1Division of Gastrointestinal and General Surgery, Department of Surgery, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston, Illinois.

Clinics in Colon and Rectal Surgery
|February 27, 2023
PubMed

Insights

Surgical site infections are complex, not just from contamination. The gut microbiome may link to distant infections via "Trojan-horse" mechanisms, even without gut barrier damage.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Surgical Outcomes

Background:

  • Surgical site infections (SSIs) are a leading cause of costly hospital readmissions.
  • Current prevention strategies, based on contamination theory, are insufficient to explain high SSI rates.
  • The contaminant theory of surgical site infection remains unproven and fails to predict most postoperative infections.

Purpose of the Study:

  • To explore the complex mechanisms underlying surgical site infection development.
  • To investigate the role of the intestinal microbiome in distant surgical site infections.
  • To propose alternative models for SSI pathogenesis beyond simple contamination.

Main Methods:

  • Review of existing literature on surgical site infections and microbiome research.
  • Analysis of evidence linking the gut microbiome to distant infections.
  • Discussion of proposed pathogenic mechanisms, including "Trojan-horse" pathways.

Main Results:

  • Surgical site infection development is more complex than simple bacterial contamination.
  • A link exists between the intestinal microbiome and distant surgical site infections.
  • Pathogens may seed surgical wounds from within the body via novel mechanisms.

Conclusions:

  • The conventional contaminant theory inadequately explains surgical site infections.
  • The intestinal microbiome represents a potential endogenous source for surgical site infections.
  • Understanding these complex interactions is crucial for improving surgical site infection prevention.
Keywords:
Trojan-horse hypothesisintestinal microbiomemetastatic infectionsurgical site infection

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