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International Journal of Colorectal Disease

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01-01-2011 | Original Article

Right colon, left colon, and rectal surgeries are not similar for surgical site infection development. Analysis of 277 elective and urgent colorectal resections

Authors: Luca Degrate, Mattia Garancini, Marta Misani, Silvia Poli, Cinzia Nobili, Fabrizio Romano, Laura Giordano, Vittorio Motta, Franco Uggeri

Published in: International Journal of Colorectal Disease | Issue 1/2011

Abstract

Purpose

Surgical site infections (SSIs) are the most common infections in colorectal surgery. Although some studies suggest that rectal surgery differs from colon surgery for SSI incidence and risk factors, the National Nosocomial Infection Surveillance system categorizes all colorectal surgeries into only one group. The aim of this study was to determine incidence, characteristics, and risk factors of SSIs according to the subclassification of colorectal surgery into right colon surgery (RCS), left colon surgery (LCS), and rectum surgery (RS).

Methods

From November 2005 to July 2009, all patients requiring colorectal resectioning were enrolled into our program. The outcome of interest was an SSI diagnosis. Univariate and multivariate analyses were performed to determine SSI predictors in each group.

Results

Two hundred seventy-seven consecutive colorectal resections were analyzed. SSI rates were 8% in RCS, 18.4% in LCS, and 17.6% in RS. LCS and RS showed significantly higher SSI incidences (p = 0.022) and greater rates of organ/space infections compared to RCS (p = 0.029). Predictors of SSI were steroid use among RCS, age greater than 70 years, multiple comorbidities, steroid use, non-neoplastic colonic disease, urgent operation, ostomy creation, postoperative intensive care among LCS, preoperative chemoradiation, heart disease, and prolonged operation among RS patients. On multivariate analysis, the coupled LCS and RS groups showed an increased risk for SSI compared to RCS (OR, 2.57).

Conclusions

SSI incidences, characteristics, and risk factors seem to be different among RCS, LCS, and RS. A tailored SSI surveillance program should be applied for each of the three groups, leading to a more competent SSI recognition and reduction of SSI incidence and related costs.

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee (1999) Guideline for prevention of surgical site infection 1999. Am J Infect Control 27(2):97–132, quiz 133–134; discussion 96CrossRefPubMed

Healthcare Infection Control Practices Advisory Committee; Centers for Disease Control and Prevention (U.S.) (2004) Guidelines for preventing health-care-associated pneumonia, 2003 recommendations of the CDC and the healthcare infection control practices advisory committee. Respir Care 49(8):926–939

Martone WJ, Nichols RL (2001) Recognition, prevention, surveillance, and management of surgical siteinfections: introduction to the problem and symposium overview. Clin Infect Dis 33(Suppl 2):S67–S68CrossRefPubMed

Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ (1999) The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 20(11):725–730CrossRefPubMed

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for prevention of surgical site infection 1999 hospital infection control practices advisory committee. Infect Control Hosp Epidemiol 20(4):250–278, quiz 279–280CrossRefPubMed

National Nosocomial Infections Surveillance (NNIS) (2004) System report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32(8):470–485CrossRef

Konishi T, Watanabe T, Kishimoto J, Nagawa H (2006) Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance. Ann Surg 244(5):758–763CrossRefPubMed

Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG, Foley EF (2004) Wound infection after elective colorectal resection. Ann Surg 239(5):599–605, discussion 605–607CrossRefPubMed

Coppa GF, Eng K, Gouge TH, Ranson JH, Localio SA (1983) Parenteral and oral antibiotics in elective colon and rectal surgery. A prospective, randomized trial. Am J Surg 145(1):62–65CrossRefPubMed

10.

Kaiser AB, Herrington JL Jr, Jacobs JK, Mulherin JL Jr, Roach AC, Sawyers JL (1983) Cefoxitin versus erythromycin, neomycin, and cefazolin in colorectal operations. Importance of the duration of the surgical procedure. Ann Surg 198(4):525–530CrossRefPubMed

11.

Goldring J, McNaught W, Scott A, Gillespie G (1975) Prophylactic oral antimicrobial agents in elective colonic surgery. A controlled trial. Lancet 2(7943):997–1000CrossRefPubMed

12.

Schoetz DJ Jr, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC (1990) Addition of parenteral cefoxitin to regimen of oral antibiotics for elective colorectal operations. A randomized prospective study. Ann Surg 212(2):209–212CrossRefPubMed

13.

Tang R, Chen HH, Wang YL, Changchien CR, Chen JS, Hsu KC, Chiang JM, Wang JY (2001) Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2, 809 consecutive patients. Ann Surg 234(2):181–189CrossRefPubMed

14.

Nichols RL, Choe EU, Weldon CB (2005) Mechanical and antibacterial bowel preparation in colon and rectal surgery. Chemotherapy 51(Suppl 1):115–121CrossRefPubMed

15.

Law WL, Chu KW (2004) Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients. Ann Surg 240(2):260–268CrossRefPubMed

16.

Shanahan F (2002) The host–microbe interface within the gut. Best Pract Res Clin Gastroenterol 16(6):915–931CrossRefPubMed

17.

Dukes CE (1932) The classification of cancer of the rectum. J Pathol Bacteriol 35:323CrossRef

18.

Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG, Banerjee SN, Edwards JR, Tolson JS, Henderson TS et al (1991) Surgical wound infection rates by wound class, operative procedure, and patient risk index. National nosocomial infections surveillance system. Am J Med 91(3B):152S–157SCrossRefPubMed

19.

Leaper DJ, van Goor H, Reilly J, Petrosillo N, Geiss HK, Torres AJ, Berger A (2004) Surgical site infection—a European perspective of incidence and economic burden. Int Wound J 1(4):247–273CrossRefPubMed

20.

Coppa GF, Eng K (1988) Factors involved in antibiotic selection in elective colon and rectal surgery. Surgery 104(5):853–858PubMed

21.

O’Hara AM, Shanahan F (2006) The gut flora as a forgotten organ. EMBO Rep 7(7):688–693CrossRefPubMed

22.

Guarner F, Malagelada JR (2003) Gut flora in health and disease. Lancet 361(9356):512–519CrossRefPubMed

23.

Blumetti J, Luu M, Sarosi G, Hartless K, McFarlin J, Parker B, Dineen S, Huerta S, Asolati M, Varela E, Anthony T (2007) Surgical site infections after colorectal surgery: do risk factors vary depending on the type of infection considered? Surgery 142(5):704–711CrossRefPubMed

24.

Kobayashi M, Mohri Y, Inoue Y, Okita Y, Miki C, Kusunoki M (2008) Continuous follow-up of surgical site infections for 30 days after colorectal surgery. World J Surg 32(6):1142–1146CrossRefPubMed

25.

Sykes PK, Brodribb RK, McLaws ML, McGregor A (2005) When continuous surgical site infection surveillance is interrupted: the Royal Hobart Hospital experience. Am J Infect Control 33(7):422–427CrossRefPubMed

26.

Petrosillo N, Drapeau CM, Nicastri E, Martini L, Ippolito G, Moro ML, ANIPIO (2008) Surgical site infections in Italian hospitals: a prospective multicenter study. BMC Infect Dis 8:34–42CrossRefPubMed

27.

Tanner J, Khan D, Aplin C, Ball J, Thomas M, Bankart J (2009) Post-discharge surveillance to identify colorectal surgical site infection rates and related costs. J Hosp Infect 72(3):243–250CrossRefPubMed

28.

Reilly J, Noone A, Clift A, Cochrane L, Johnston L, Rowley DI, Phillips G, Sullivan F (2005) A study of telephone screening and direct observation of surgical wound infections after discharge from hospital. J Bone Joint Surg Br 87(7):997–999CrossRefPubMed

29.

Rovera F, Dionigi G, Boni L, Piscopo C, Masciocchi P, Alberio MG, Carcano G, Diurni M, Dionigi R (2007) Infectious complications in colorectal surgery. Surg Oncol 16(Suppl 1):S121–S124CrossRefPubMed

30.

Nakamura T, Mitomi H, Ihara A, Onozato W, Sato T, Ozawa H, Hatade K, Watanabe M (2008) Risk factors for wound infection after surgery for colorectal cancer. World J Surg 32(6):1138–1141CrossRefPubMed

31.

Uchino M, Ikeuchi H, Tsuchida T, Nakajima K, Tomita N, Takesue Y (2009) Surgical site infection following surgery for inflammatory bowel disease in patients with clean-contaminated wounds. World J Surg 33(5):1042–1048CrossRefPubMed

32.

Sorensen LT, Jorgensen T, Kirkeby LT, Skovdal J, Vennits B, Wille-Jorgensen P (1999) Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery. Br J Surg 86(7):927–931CrossRefPubMed

33.

Knighton DR, Halliday B, Hunt TK (1984) Oxygen as an antibiotic. The effect of inspired oxygen on infection. Arch Surg 119(2):199–204PubMed

34.

Kurz A, Sessler DI, Lenhardt R (1996) Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of wound infection and temperature group. N Engl J Med 334(19):1209–1215CrossRefPubMed

Title: Right colon, left colon, and rectal surgeries are not similar for surgical site infection development. Analysis of 277 elective and urgent colorectal resections
Authors: Luca Degrate
Mattia Garancini
Marta Misani
Silvia Poli
Cinzia Nobili
Fabrizio Romano
Laura Giordano
Vittorio Motta
Franco Uggeri
Publication date: 01-01-2011
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 1/2011
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-010-1057-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Right colon, left colon, and rectal surgeries are not similar for surgical site infection development. Analysis of 277 elective and urgent colorectal resections

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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