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Published in:

01-10-2006

Site-Specific Patterns of Surgical Site Infections and Their Early Indicators After Elective Colorectal Cancer Surgery

Authors: Chikao Miki, M.D., Yasuhiro Inoue, M.D., Yasuhiko Mohri, M.D., Minako Kobayashi, M.D., Masato Kusunoki, M.D.

Published in: Diseases of the Colon & Rectum | Special Issue 1/2006

Purpose

We sought to determine site-specific patterns of risk factors for incisional and organ/space surgical site infections in patients with colorectal cancer to develop predictive models using inflammatory mediators.

Methods

We analyzed data for 285 consecutive elective patients at our institution. The surgical site infections were grouped as incisional or organ/space according to the criteria of the Centers for Disease Control and Prevention. Peripheral venous blood samples were obtained perioperatively and the serum interleukin-6, interleukin-1 receptor antagonist, and interleukin-6 soluble receptor levels were measured.

Results

Surgical site infections were identified in 60 of 285 patients (21 percent) and included 27 incisional surgical site infections and 33 organ/space surgical site infections. The perioperative risk factors for incisional surgical site infections included male gender, operating time, operative blood loss, blood transfusion, tumor location, and concomitant medical problems, whereas those for organ/space surgical site infections were operating time, operative blood loss, blood transfusion, tumor location, obesity, and concomitant medical problems. A multivariate logistic regression analysis revealed that operating time and concomitant medical problems were independent common factors that predicted both incisional and organ/space surgical site infections. Postoperatively, an intense postoperative increase in the serum interleukin-6 level predicted both incisional and organ/space surgical site infections. In contrast, the maximum postoperative systemic consumption of interleukin-6 soluble receptor could differentiate the odds of developing organ/space surgical site infections from those of developing incisional surgical site infections.

Conclusions

The risk factors and indicators for incisional and organ/space surgical site infections after surgery for colorectal carcinoma differ, suggesting different mechanisms for their pathogenesis. A postoperative decrease in the serum interleukin-6 soluble receptor level may be an early predictor for organ/space surgical site infections.

Boyce, JM 2001Antiseptic technology: access, affordability, and acceptanceEmerg Infect Dis7231233PubMedCrossRef

Culver, DH, Horan, TC, Gaynes, RP, et al. 1991Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance SystemAm J Med91S152S157CrossRef

Taylor, GJ, Mikell, FL, Moses, HW, et al. 1990Determinants of hospital charges for coronary artery bypass surgery: the economic consequences of postoperative complicationsAm J Cardiol65309313PubMedCrossRef

Antonelli, M, Raponi, GM, Martino, P, et al. 1995High IL-6 serum levels are associated with septic shock and mortality in septic patients with severe leukopenia due to hematological malignanciesScand J Infect Dis27381384PubMed

Buck, C, Bundschu, J, Gallati, H, Bartmann, P, Pohlandt, F 1994Interleukin-6: a sensitive parameter for the early diagnosis of neonatal bacterial infectionPediatrics935458PubMed

Messer, J, Eyer, D, Donato, L, Gallati, H, Matis, J, Simeoni, U 1996Evaluation of interleukin-6 and soluble receptors of tumor necrosis factor for early detection of neonatal infectionJ Pediatr129574580PubMedCrossRef

Hauser, GJ, Ben Ari, J, Colvin, MP, et al. 1998Interleukin-6 levels in serum and lung lavage fluid of children undergoing open heart surgery correlate with postoperative morbidityIntensive Care Med24481486PubMedCrossRef

Tang, R, Chen, HH, Wang, YL, et al. 2001Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2,809 consecutive patientsAnn Surg234181189PubMedCrossRef

Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR 1999Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory CommitteeInfect Control Hosp Epidemiol20250278PubMedCrossRef

10.

Bistrian, BR, Blackburn, GL, Sherman, M, Scrimshaw, NS 1975Therapeutic index of nutritional depletion in hospitalized patientsSurg Gynecol Obstet141512516PubMed

11.

Hoeyweghen, RJ, Leeuw, IH, Vandewoude, MF 1992Creatinine arm index as alternative for creatinine height indexAm J Clin Nutr56611615PubMed

12.

Killingback, M, Barron, P, Dent, O 2002Elective resection and anastomosis for colorectal cancer: a prospective audit of mortality and morbidity 1976–1998ANZ J Surg72689698PubMedCrossRef

13.

Horzic, M, Kopljar, M 2005Postoperative infections in colorectal cancer patientsHepatogastroenterology52101104PubMed

14.

Vamvakas, EC, Carven, JH 1998Transfusion of white-cell containing allogeneic blood components and postoperative wound infection: effect of confounding factorsTransfus Med82936PubMedCrossRef

15.

Christian, CK, Kwaan, MR, Betensky, RA, Breen, EM, Zinner, MJ, Bleday, R 2005Risk factors for perineal wound complications following abdominoperineal resectionDis Colon Rectum484348PubMedCrossRef

16.

Steinhoff, G, Behrend, M, Wonigeit, K 1990Expression of adhesion molecules on lymphocytes/monocytes and hepatocytes in human liver graftsHum Immunol28123127PubMedCrossRef

17.

Bishop, DK, Jutila, MA, Sedmak, DD 1989Lymphocyte entry into inflammatory tissues in vivo. Qualitative differences of high endothelial venule-like vessels in sponge matrix allografts vs isograftsJ Immunol14242194224PubMed

18.

Molloy, RG, Mannick, JA, Rodrick, ML 1993Cytokines, sepsis and immunomodulationBr J Surg80289297PubMed

19.

Romano, M, Sironi, M, Toniatti, C, et al. 1997Role of IL-6 and its soluble receptor in induction of chemokines and leukocyte recruitmentImmunity6315325PubMedCrossRef

20.

Ostermann, H, Kratz-Albers, K, Mesters, RM, Kiehl, M, Kienast, J 1997Reciprocal changes in circulating interleukin-6 and its soluble receptor during evolving sepsis in leukocytopenic patientsJ Infect Dis176825828PubMedCrossRef

21.

Hisano, S, Sakamoto, K, Ishiko, T, Kamohara, H, Ogawa, M 1997IL-6 and soluble IL-6 receptor levels change differently after surgery both in the blood and in the operative fieldCytokine9447452PubMedCrossRef

Title: Site-Specific Patterns of Surgical Site Infections and Their Early Indicators After Elective Colorectal Cancer Surgery
Authors: Chikao Miki, M.D.
Yasuhiro Inoue, M.D.
Yasuhiko Mohri, M.D.
Minako Kobayashi, M.D.
Masato Kusunoki, M.D.
Publication date: 01-10-2006
Publisher: Springer-Verlag
Published in: Diseases of the Colon & Rectum / Issue Special Issue 1/2006
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI: https://doi.org/10.1007/s10350-006-0696-x

At a glance: The STEP trials

Springer Medicine

Site-Specific Patterns of Surgical Site Infections and Their Early Indicators After Elective Colorectal Cancer Surgery

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Purpose

Methods

Results

Conclusions

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