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Surgical site infection among patients after colorectal cancer surgery

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Banaszkiewicz Z., Cierzniakowska K., Tojek K., Kozłowska E., Jawień A.
Polish Journal of Surgery
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2017
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vol. 89(1)
9-15
EN
Wstęp: Zakażenie miejsca operowanego występuje u 2,5–22,3% operowanych chorych. Jest ono wykładnikiem jakości leczenia na oddziałach zabiegowych i ma duży wpływ na jego koszt. Materiał i metodyka: Analizie poddano chorych, u których w obserwacji 30-dniowej wystąpiło zakażenie miejsca operowanego. Grupę wyjściową stanowiło 1581 chorych z rozpoznaniem raka jelita grubego poddanych zabiegowi operacyjnemu w jednym ośrodku. Kryteriami wyłączającymi z badania były: brak wiarygodnej dokumentacji leczenia (szpitalnego lub ambulatoryjnego) i zgon chorego przed 30. dniem po operacji bez rozpoznanego zakażenia miejsca operowanego. Analizę statystyczną wykonano przy użyciu programu Statistica 10. Wyniki: Powikłania pooperacyjne wystąpiły u 262 chorych (16,6%). Najczęściej występującym było zakażenie miejsca operowanego (198 pacjentów; 12,52%). Stwierdzono, że wystąpienie tego powikłania zależne było od zaawansowania klinicznego raka, wieku chorych, chorób współtowarzyszących (cukrzyca i choroby kardiologiczne). Ponadto zauważono, że powikłanie to występowało znamiennie częściej u chorych operowanych w trybie pilnym z powodu powikłań oraz u tych, u których wyłoniono stomię jelitową. Nie stwierdzono natomiast zależności wystąpienia tego powikłania od płci chorych i lokalizacji guza nowotworowego. Wniosek: U chorych po operacji raka jelita grubego największe zagrożenie wystąpienia zakażenia miejsca operowanego wystąpiło u chorych po 75. roku życia, obciążonych cukrzycą i chorobami kardiologicznymi, z dużym zaawansowaniem klinicznym raka, operowanych w trybie ostrego dyżuru, u których konieczne było wyłonienie stomii jelitowej (a szczególnie kolostomii).
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Prevalence and characteristics of surgical site infections caused by gram-negative rod-shaped bacteria from the family Enterobacteriacae and gram-positive cocci from the genus Staphylococcus in patients who underwent surgical procedures on selected surgical wards

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Tomaszewska-Kowalska M., Kołomecki K., Wieloch-Torzecka M.
Polish Journal of Surgery
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2016
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vol. 88(5)
433-447
EN
Surgical site infections on surgical wards are the most common cause of postoperative complications. Prevalence of surgical site infections depends on the surgical specialization. Analysis of the causes of surgical site infections allows to conclude that microorganisms from the patient’s own microbiota – Gram-negative rod-shaped bacteria from the family Enterobacteriacae and from the patient’s skin microbiota – Gram-positive cocci – Staphylococcus are the most common agents inducing surgical site infections. The aim of the study was to assess prevalence and characteristics of surgical site infections caused by Gram-negative rod-shaped bacteria from the family Eneterobacteriacae and Gram-positive cocci from the genus Staphylococcus in patients who underwent surgical procedures at the Regional Specialist Hospital named after M. Copernika in Łódź on selected surgical wards. Material and methods. The study was performed based on retrospective analysis of medical documentation of the treated patients. The study included 195 patients of the Regional Specialist Hospital named after M. Copernik in Łódź who were treated between 2012 and 2014 on the wards of: Vascular, General and Oncological Surgery, Trauma and Orthopaedic Surgery, Neosurgery and Nervous System Tumors and the Ward of Endocrine Surgery – in the Clinic of Endocrine Surgery. The study included 84 women and 111 men. Mean age was 59 years (18 – 94 years old). \ Results. Surgical site infections caused by Gram-negative rod-shaped bacteria from the family Enterobacteriacae were reported in 84 out of 195 patients (43.08% of the study group) and by Gram-positive cocci from the genus Staphylococcus were reported in 52 patients (26.67% of the study group). Mixed microbiota was an etiological agent of surgical site infections in four patients (2.5% of the study group). Conclusions. Etiological agent of surgical site infections depends on the ward profile, surgical field cleanliness and a form of surgical site infection.
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Influence of Intraoperative Iodine Solution Lavage Followed by "Wound Scrubbing" Technique on SSI Frequency

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Wojciechowicz T., Dobosz M., Folwarski M.
Polish Journal of Surgery
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2010
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vol. 82
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issue 8
464-468
EN
The aim of the study was to assess whether intraoperative use of the "wound scrubbing" technique (iodine solution lavage followed by intensive scrubbing of the wound with a surgical drape) reduces the number of surgical site infection (SSI) incidents, considering patients after colorectal surgery.Material and methods. The study group comprised 98 patients qualified towards colorectal surgery during the period between November, 2007 and November, 2008. Patients were divided into two groups: Fifty patients were subject to the "wound scrubbing" technique (group I), while 48 patients constituted the control group (group II) where the wound was treated traditionally-subcutaneous tissue hemostasis was assured, least traumatically. In case of both groups subcutaneous tissue swabs were collected before wound suturing. Primary cutaneous sutures were applied in all patients. The diagnosis of a surgical site infection was based on the criteria established by the National Nosocomial Infectious Surveillance (NNIS) group.Results. According to the NNIS criteria, superficial SSI was diagnosed in 12 patients (12.3%): 4 from the "wound scrubbing" group (8%) and 8 from the control group (16.7%). Deep tissue infections were not observed. Gram-negative bacteria were most often isolated, both in case of group II patients, and SSI cases. Considering the "wound scrubbing" group 66% of intraoperative swabs proved to be sterile.Conclusions. 1. The "wound scrubbing" technique reduces the risk of SSI in case of patients subject to colorectal surgery. 2. Microbial contamination of the postoperative wound (groups II-IV, according to the NNIS) before the introduction of cutaneous sutures directly influences the frequency of surgical site infections.
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Surgical site infection– the authors’ own prospective research

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Neuman D., Grzebieniak Z.
Polish Journal of Surgery
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2015
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vol. 86
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issue 1
26-32
EN
Surgical site infection is a common complication in surgery, which increases treatment cost, extends hospitalization time and can lead to septic complications. The aim of the study was analysis of postoperative infections in own material and finding significant risk factors with preserving the obligatory procedures in the clinic. Material and methods. Prospective analysis of 270 consecutively operated patients aged from 18 to 101 was performed with observation of early infection until 7th day postoperatively. Factors judged included: age, sex, BMI, operation type: elective or urgent, physical preparation for surgery, antibiotic prophylaxis, length and type of surgery. Wound observation card was used. Data were analysed statistically (t-Student’s test, chi2 test, U Mann Whitney test and logistic regression analysis). Results. Wound infection was observed in 33 patients (12.22% of the entire group). In 24 (8.88%) it was a superficial infection and in 9 (3.33%) deep infection. Statistically significant risk factors were age, presence of diabetes, operation time and operations on large bowel. The average age of patients with present infection was 61.2. In the group without infection there were 6,3% patients with diabetes and 20.8% in the group with infection. In our study diabetes increased the risk of infection four times. The longer the operation time the higher was the risk of deep infection (without complications 76.2 minutes, superficial 94.9 minutes, deep 148.9 minutes). Operations on large bowel were performed in 11.9%of all study patients. In the group of 33 patients with surgical wound infection, 39.4% had colon surgery, 39.4% of all deep infections and 29.2% of all superficial infections. Conclusions. In own study material significant risk factors of surgical wound infection were: age, presence of diabetes, length of operation, large bowel surgery. In preoperative course risk factors should be identified to perform certain prophylactic procedures to lower the risk of infectious complications.
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