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Open Access 01-12-2023 | Abdominal Surgery | Research

Rectal colonization is predictive for surgical site infections with multidrug-resistant bacteria in abdominal surgery

Published in: Langenbeck's Archives of Surgery | Issue 1/2023

Abstract

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.

Kwa KAA, Krijnen P, Bernards AT, Schipper IB, Meij-de Vries A, Breederveld RS (2020) Bacterial species and load increase during negative pressure wound therapy: a prospective cohort study. Wounds 32(3):74–80PubMed

Nahid MA, Griffin JM, Lustik MB, Hayes JJ, Fong KSK, Horseman TS et al (2021) A longitudinal evaluation of the bacterial pathogens colonizing chronic non-healing wound sites at a United States military treatment facility in the Pacific region. Infect Drug Resist 14:1–10. https://doi.org/10.2147/IDR.S260708CrossRefPubMedPubMedCentral

Mehdorn M, Kassahun WT, Lippmann N, Scheuermann U, Groos L, Buchloh D et al (2021) Surgical revision promotes presence of Enterococcus spp. in abdominal superficial surgical site infections. J Gastrointest Surg 26(2):444–452. https://doi.org/10.1007/s11605-021-05170-3

Kassavin DS, Pascarella L, Goldfarb MA (2011) Surgical site infections: incidence and trends at a community teaching hospital. Am J Surg 201(6):749–753. https://doi.org/10.1016/j.amjsurg.2010.03.002CrossRefPubMed

Raouf M, Ghazal T, Kassem M, Agamya A, Amer A (2020) Surveillance of surgical-site infections and antimicrobial resistance patterns in a tertiary hospital in Alexandria, Egypt. J Infect Dev Ctries 14(3):277–283. https://doi.org/10.3855/jidc.12124CrossRefPubMed

Werner G, Neumann B, Weber RE, Kresken M, Wendt C, Bender JK et al (2020) Thirty years of VRE in Germany - “expect the unexpected”: the view from the National Reference Centre for Staphylococci and Enterococci. Drug Resist Updat 53:100732. https://doi.org/10.1016/j.drup.2020.100732CrossRefPubMed

Upreti N, Rayamajhee B, Sherchan SP, Choudhari MK, Banjara MR (2018) Prevalence of methicillin resistant Staphylococcus aureus, multidrug resistant and extended spectrum beta-lactamase producing gram negative bacilli causing wound infections at a tertiary care hospital of Nepal. Antimicrob Resist Infect Control 7:121. https://doi.org/10.1186/s13756-018-0408-zCrossRefPubMedPubMedCentral

Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A et al (2022) Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 399(10325):629–655. https://doi.org/10.1016/s0140-6736(21)02724-0CrossRef

El-Saed A, Balkhy HH, Alshamrani MM, Aljohani S, Alsaedi A, Al Nasser W et al (2020) High contribution and impact of resistant gram negative pathogens causing surgical site infections at a multi-hospital healthcare system in Saudi Arabia, 2007–2016. BMC Infect Dis 20(1):275. https://doi.org/10.1186/s12879-020-4939-6CrossRefPubMedPubMedCentral

10.

Lubbert C, Baars C, Dayakar A, Lippmann N, Rodloff AC, Kinzig M et al (2017) Environmental pollution with antimicrobial agents from bulk drug manufacturing industries in Hyderabad, South India, is associated with dissemination of extended-spectrum beta-lactamase and carbapenemase-producing pathogens. Infection 45(4):479–491. https://doi.org/10.1007/s15010-017-1007-2CrossRefPubMed

11.

Acquisto NM, Bodkin RP, Brown JE, Graman PS, Jones CMC, Li T et al (2018) MRSA nares swab is a more accurate predictor of MRSA wound infection compared with clinical risk factors in emergency department patients with skin and soft tissue infections. Emerg Med J 35(6):357–360. https://doi.org/10.1136/emermed-2017-206843CrossRefPubMed

12.

Takara D, Sugawara G, Ebata T, Yokoyama Y, Igami T, Nagino M (2011) Preoperative biliary MRSA infection in patients undergoing hepatobiliary resection with cholangiojejunostomy: incidence, antibiotic treatment, and surgical outcome. World J Surg 35(4):850–857. https://doi.org/10.1007/s00268-011-0990-1CrossRefPubMed

13.

Sanjay P, Fawzi A, Kulli C, Polignano FM, Tait IS (2010) Impact of methicillin-resistant Staphylococcus Aureus (MRSA) infection on patient outcome after pancreatoduodenectomy (PD)–a cause for concern? Pancreas 39(8):1211–1214. https://doi.org/10.1097/MPA.0b013e3181e00cadCrossRefPubMed

14.

Schoevaerdts D, Verroken A, Huang TD, Frennet M, Berhin C, Jamart J et al (2012) Multidrug-resistant bacteria colonization amongst patients newly admitted to a geriatric unit: a prospective cohort study. J Infect 65(2):109–118. https://doi.org/10.1016/j.jinf.2012.02.004CrossRefPubMed

15.

Bardossy AC, Alsafadi MY, Starr P, Chami E, Pietsch J, Moreno D et al (2017) Evaluation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus. Am J Infect Control 45(12):1369–1371. https://doi.org/10.1016/j.ajic.2017.06.017CrossRefPubMed

16.

American Center for Disease Control and Prevention (2023). https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf. Accessed 19 Nov 2022

17.

KRINKO (2012) Hygiene measures for infection or colonization with multidrug-resistant gram-negative bacilli. Commission recommendation for hospital hygiene and infection prevention (KRINKO) at the Robert Koch Institute (RKI). Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 55(10):1311–54. https://doi.org/10.1007/s00103-012-1549-5CrossRef

18.

KRINKO (2018) Hygienemaßnahmen zur Prävention der Infektion durch Enterokokken mit speziellen Antibiotikaresistenzen. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 61(10):1310–61. https://doi.org/10.1007/s00103-018-2811-2CrossRef

19.

Ruscher C (2014) Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 57(6):695–732. https://doi.org/10.1007/s00103-014-1980-xCrossRef

20.

The European Committee on Antimicrobial Susceptibility and Testing (2021) Breakpoint tables for Interpretation of MICs and zone diameters. version 11.0. 2021. http://www.eucast.org. Accessed 06 Apr 2021

21.

Kalra L, Camacho F, Whitener CJ, Du P, Miller M, Zalonis C et al (2013) Risk of methicillin-resistant Staphylococcus aureus surgical site infection in patients with nasal MRSA colonization. Am J Infect Control 41(12):1253–1257. https://doi.org/10.1016/j.ajic.2013.05.021CrossRefPubMed

22.

Sugimachi K, Iguchi T, Mano Y, Morita M, Mori M, Toh Y (2019) Significance of bile culture surveillance for postoperative management of pancreatoduodenectomy. World J Surg Oncol 17(1):232. https://doi.org/10.1186/s12957-019-1773-7CrossRefPubMedPubMedCentral

23.

Huttner B, Robicsek AA, Gervaz P, Perencevich EN, Schiffer E, Schrenzel J et al (2012) Epidemiology of methicillin-resistant Staphylococcus aureus carriage and MRSA surgical site infections in patients undergoing colorectal surgery: a cohort study in two centers. Surg Infect (Larchmt) 13(6):401–405. https://doi.org/10.1089/sur.2011.107CrossRefPubMed

24.

Furukawa K, Onda M, Suzuki H, Maruyama H, Akiya Y, Ashikari M et al (1999) The usefulness of conducting investigations on intra-abdominal bacterial contamination in digestive tract operations. Surg Today 29(8):701–706. https://doi.org/10.1007/bf02482312CrossRefPubMed

25.

Mehdorn M, Lubbert C, Chaberny IF, Gockel I, Jansen-Winkeln B (2021) Mechanical plus oral bowel preparation with paromomycin and metronidazole reduces infectious complications in elective colorectal surgery: a matched case-control study. Int J Colorectal Dis 36(9):1839–1849. https://doi.org/10.1007/s00384-021-03931-9CrossRefPubMedPubMedCentral

26.

Berrios-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR et al (2017) Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 152(8):784–791. https://doi.org/10.1001/jamasurg.2017.0904CrossRefPubMed

27.

Strobel RM, Leonhardt M, Krochmann A, Neumann K, Speichinger F, Hartmann L et al (2020) Reduction of postoperative wound infections by antiseptica (RECIPE)?: a randomized controlled trial. Ann Surg 272(1):55–64. https://doi.org/10.1097/SLA.0000000000003645CrossRefPubMed

28.

McGuirk M, Kajmolli A, Gachabayov M, Samson D, Latifi R (2020) Timing and type of bacteria in surgical site infections following complex abdominal wall reconstruction. Surg Technol Int 37:27–34PubMed

29.

Kajova M, Khawaja T, Kantele A (2022) European hospitals as source of multidrug-resistant bacteria: analysis of travellers screened in Finland after hospitalization abroad. J Travel Med 29(4):taac022. https://doi.org/10.1093/jtm/taac022

30.

Kajova M, Khawaja T, Kangas J, Makinen H, Kantele A (2021) Import of multidrug-resistant bacteria from abroad through interhospital transfers, Finland, 2010–2019. Euro Surveill 26(39):2001360. https://doi.org/10.2807/1560-7917.ES.2021.26.39.2001360CrossRefPubMedPubMedCentral

31.

Salmanov AG, Bondar TP, Shkorbotun YV, Chumak EA, Shkorbotun VO, Dementieva OV et al (2020) Prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus among healthcare workers in the Departments of Otorhinolaryngology and Dentistry in Kyiv, Ukraine. Wiad Lek 73(12 cz 1):2563–7

32.

Jannasch O, Kelch B, Adolf D, Tammer I, Lodes U, Weiss G et al (2015) Nosocomial infections and microbiologic spectrum after major elective surgery of the pancreas, liver, stomach, and esophagus. Surg Infect (Larchmt) 16(3):338–345. https://doi.org/10.1089/sur.2013.248CrossRefPubMed

33.

Pal S, Sayana A, Joshi A, Juyal D (2019) Staphylococcus aureus: a predominant cause of surgical site infections in a rural healthcare setup of Uttarakhand. J Family Med Prim Care 8(11):3600–3606. https://doi.org/10.4103/jfmpc.jfmpc_521_19CrossRefPubMedPubMedCentral

34.

Yang Z, Wang J, Wang W, Zhang Y, Han L, Zhang Y et al (2015) Proportions of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus in patients with surgical site infections in mainland China: a systematic review and meta-analysis. PLoS One 10(1):e0116079. https://doi.org/10.1371/journal.pone.0116079CrossRefPubMedPubMedCentral

35.

Bediako-Bowan AAA, Kurtzhals JAL, Molbak K, Labi AK, Owusu E, Newman MJ (2020) High rates of multi-drug resistant gram-negative organisms associated with surgical site infections in a teaching hospital in Ghana. BMC Infect Dis 20(1):890. https://doi.org/10.1186/s12879-020-05631-1CrossRefPubMedPubMedCentral

36.

Davoudi A, Najafi N, Alian S, Tayebi A, Ahangarkani F, Rouhi S et al (2015) Resistance pattern of antibiotics in patient underwent open heart surgery with nosocomial infection in North of Iran. Glob J Health Sci 8(2):288–297. https://doi.org/10.5539/gjhs.v8n2p288CrossRefPubMedPubMedCentral

37.

Freire MP, Song ATW, Oshiro ICV, Andraus W, D'Albuquerque LAC, Abdala E (2021) Surgical site infection after liver transplantation in the era of multidrug-resistant bacteria: what new risks should be considered? DiagnMicrobiol Infect Dis 99(1):115220.https://doi.org/10.1016/j.diagmicrobio.2020.115220

38.

Rubio-Perez I, Martin-Perez E, Domingo-García D, Garcia-Olmo D (2017) Specific clinical profile and risk factors for mortality in general surgery patients with infections by multi-drug-resistant gram-negative bacteria. Surg Infect (Larchmt) 18(5):625–633. https://doi.org/10.1089/sur.2016.255CrossRefPubMed

39.

Wijnakker R, Lambregts MMC, Rump B, Veldkamp KE, Reis R, Visser LG et al (2020) Limited multi-drug resistant organism related stigma in carriers exposed to isolation precautions: an exploratory quantitative questionnaire study. J Hosp Infect 106(1):126–133. https://doi.org/10.1016/j.jhin.2020.06.034CrossRefPubMed

40.

Eisner R, Lippmann N, Josten C, Rodloff AC, Behrendt D (2020) Development of the bacterial spectrum and antimicrobial resistance in surgical site infections of trauma patients. Surg Infect (Larchmt) 21(8):684–693. https://doi.org/10.1089/sur.2019.158CrossRefPubMed

41.

Gast KB, van Oudheusden AJG, Murk JL, Stohr J, Buiting AG, Verweij JJ (2021) Successful containment of two vancomycin-resistant Enterococcus faecium (VRE) outbreaks in a Dutch teaching hospital using environmental sampling and whole-genome sequencing. J Hosp Infect 111:132–139. https://doi.org/10.1016/j.jhin.2021.02.007CrossRefPubMed

42.

Mathis B, Haine M, Girard R, Bonnefoy M (2019) Risk factors for vancomycin-resistant enterococcus acquisition during a large outbreak in patients aged 65 years and older. BMC Geriatr 19(1):377. https://doi.org/10.1186/s12877-019-1398-2CrossRefPubMedPubMedCentral

43.

Vuichard-Gysin D, Sommerstein R, Kronenberg A, Buetti N, Eder M, Piezzi V et al (2022) High adherence to national IPC guidelines as key to sustainable VRE control in Swiss hospitals: a cross-sectional survey. Antimicrob Resist Infect Control 11(1):19. https://doi.org/10.1186/s13756-022-01051-9CrossRefPubMedPubMedCentral

44.

Franyo D, Kocsi B, Bukta EE, Szabo J, Dombradi Z (2020) Assessing the intestinal carriage rates of vancomycin-resistant enterococci (VRE) at a tertiary care hospital in Hungary. Folia Microbiol (Praha) 65(3):483–490. https://doi.org/10.1007/s12223-019-00751-xCrossRefPubMed

45.

Heininger A, Zimmermann S, Bootsveld C, Boutin S, Nurjadi D (2020) Low prevalence of combined linezolid- and vancomycin-resistant Enterococcus faecium from hospital admission screening in an endemic region in Germany. J Glob Antimicrob Resist 22:646–650. https://doi.org/10.1016/j.jgar.2020.05.003CrossRefPubMed

46.

Janjusevic A, MarkovicDenic L, Minic R, Grgurevic A, Cirkovic I (2021) Intestinal carriage of vancomycin-resistant Enterococcus spp. among high-risk patients in university hospitals in Serbia: first surveillance report. Ann Clin Microbiol Antimicrob 20(1):18. https://doi.org/10.1186/s12941-021-00423-0CrossRefPubMedPubMedCentral

47.

Skjot-Arkil H, Mogensen CB, Lassen AT, Johansen IS, Chen M, Petersen P et al (2019) Carrier prevalence and risk factors for colonisation of multiresistant bacteria in Danish emergency departments: a cross-sectional survey. BMJ Open 9(6):e029000. https://doi.org/10.1136/bmjopen-2019-029000CrossRefPubMedPubMedCentral

48.

Hernandez-Jimenez P, Lopez-Medrano F, Fernandez-Ruiz M, Silva JT, Corbella L, San-Juan R et al (2022) Derivation of a score to predict infection due to multidrug-resistant Pseudomonas aeruginosa: a tool for guiding empirical antibiotic treatment. J Glob Antimicrob Resist 29:215–221. https://doi.org/10.1016/j.jgar.2022.03.014CrossRefPubMed

49.

Rump B, Timen A, Verweij M, Hulscher M (2019) Experiences of carriers of multidrug-resistant organisms: a systematic review. Clin Microbiol Infect 25(3):274–279. https://doi.org/10.1016/j.cmi.2018.10.007CrossRefPubMed

50.

Ling W, Peri AM, Furuya-Kanamori L, Harris PNA, Paterson DL (2022) Carriage duration and household transmission of enterobacterales producing extended-spectrum beta-lactamase in the community: a systematic review and meta-analysis. Microb Drug Resist 28(7):795–805. https://doi.org/10.1089/mdr.2022.0035CrossRefPubMed

51.

Nys S, Bruinsma N, Filius PM, van den Bogaard AE, Hoffman L, Terporten PH et al (2005) Effect of hospitalization on the antibiotic resistance of fecal Enterococcus faecalis of surgical patients over time. Microb Drug Resist 11(2):154–158. https://doi.org/10.1089/mdr.2005.11.154CrossRefPubMed

Title: Rectal colonization is predictive for surgical site infections with multidrug-resistant bacteria in abdominal surgery
Publication date: 01-12-2023
Keywords: Abdominal Surgery
Postoperative Wound Infection
Postoperative Wound Infection
Published in: Langenbeck's Archives of Surgery / Issue 1/2023
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-023-02961-x

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

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Rectal colonization is predictive for surgical site infections with multidrug-resistant bacteria in abdominal surgery

Abstract

Purpose

Methods

Results

Conclusion

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

2024 ESC Congress

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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