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Rectal colonization is predictive for surgical site infections with multidrug-resistant bacteria in abdominal surgery
Matthias Mehdorn1, Susanne Kolbe-Busch2, Norman Lippmann3
1Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany. Matthias.mehdorn@medizin.uni-leipzig.de.
Purpose:
Superficial surgical site infections (SSI) are a common complication after abdominal surgery. Additionally, multidrug-resistant organisms (MDRO) have shown an increasing spread in recent years with a growing importance for health care. As there is varying evidence on the importance of MDRO in different surgical fields and countries as causative agents of SSI, we report our findings of MDRO-caused SSI.
Methods:
We assembled an institutional wound register spanning the years 2015-2018 including all patients with abdominal surgery and SSI only, including demographics, procedure-related data, microbiological data from screenings, and body fluid samples. The cohort was examined for the frequency of different MDRO in screenings, body fluids, and wound swabs and assessed for risk factors for MDRO-positive SSI.
Results:
A total of 138 out of 494 patients in the register were positive for MDRO, and of those, 61 had an MDRO isolated from their wound, mainly multidrug-resistant Enterobacterales (58.1%) followed by vancomycin-resistant Enterococcus spp. (19.7%). As 73.2% of all MDRO-carrying patients had positive rectal swabs, rectal colonization could be identified as the main risk factor for an SSI caused by a MDRO with an odds ratio (OR) of 4.407 (95% CI 1.782-10.896, p = 0.001). Secondly, a postoperative ICU stay was also associated with an MDRO-positive SSI (OR 3.73; 95% CI 1.397-9.982; p = 0.009).
Conclusion:
The rectal colonization status with MDRO should be taken into account in abdominal surgery regarding SSI prevention strategies. Trial registration Retrospectively registered in the German register for clinical trials (DRKS) 19th December 2019, registration number DRKS00019058.
Insights
Rectal colonization is a primary risk factor for multidrug-resistant organism (MDRO) surgical site infections (SSI) after abdominal surgery. Identifying rectal colonization can improve SSI prevention strategies for MDROs.
Area of Science:
- Surgical infections
- Microbiology
- Infectious disease epidemiology
Background:
- Superficial surgical site infections (SSI) are common after abdominal surgery.
- Multidrug-resistant organisms (MDRO) pose a growing healthcare challenge.
- Evidence on MDROs as SSI agents varies across surgical fields and regions.
Purpose of the Study:
- To investigate the prevalence and risk factors of MDRO-caused SSI in abdominal surgery patients.
- To identify specific MDROs causing SSI and their sources.
- To inform SSI prevention strategies regarding MDROs.
Main Methods:
- Analysis of an institutional wound register (2015-2018) for abdominal surgery patients with SSI.
- Inclusion of demographics, procedural data, and microbiological data (screenings, body fluids, wound swabs).
- Assessment of MDRO frequency and risk factors for MDRO-positive SSI.
Main Results:
- 138 of 494 patients (27.9%) were positive for MDRO; 61 had MDRO isolated from wounds.
- Multidrug-resistant Enterobacterales (58.1%) and vancomycin-resistant Enterococcus spp. (19.7%) were predominant MDROs.
- Rectal colonization (73.2% of MDRO-carrying patients) was the main risk factor (OR 4.407), followed by postoperative ICU stay (OR 3.73).
Conclusions:
- Rectal colonization with MDROs is a significant risk factor for SSI in abdominal surgery.
- Incorporating rectal colonization status into SSI prevention is recommended.
- Further research may focus on targeted interventions based on colonization status.
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