surgical site infection

{{Short description|Infection that occurs at the site of a surgical procedure}}

A surgical site infection (SSI) develop when bacteria infiltrate the body through surgical incisions.{{cite web | last=Ly | first=Chen | title=Post-surgery infections may mainly be caused by skin bacteria | website=New Scientist | date=10 Apr 2024 | url=https://www.newscientist.com/article/2426356-post-surgery-infections-may-mainly-be-caused-by-skin-bacteria/ | access-date=27 Nov 2024}} These bacteria may come from the patient's own skin, the surgical instruments, or the environment in which the procedure is performed.{{cite web | title=Surgical site infection | website=

World Health Organization (WHO)

| date=1 Jan 1900 | url=https://www.who.int/teams/integrated-health-services/infection-prevention-control/surgical-site-infection | ref={{sfnref| World Health Organization (WHO) |1900}} | access-date=27 Nov 2024}}

An infection is designated as an SSI if it develops at the site of a surgical wound, either because of contamination during surgery or as a result of postoperative complications. For the infection to be classified as an SSI, it should occur within 30 days after surgery or within 1 year if an implant is involved.{{cite web | last1=Zabaglo | first1=Mate | last2=Leslie | first2=Stephen W. | last3=Sharman | first3=Tariq | title=Postoperative Wound Infections | publisher=StatPearls Publishing | date=5 Mar 2024 | pmid=32809368 | url=https://www.ncbi.nlm.nih.gov/books/NBK560533/ | access-date=27 Nov 2024}}

Surgical site infections that are limited to the skin and subcutaneous tissues are classified as superficial incisional SSIs. These infections are the most common type, accounting for more than 50% of all reported surgical site infections.

Symptoms

The symptoms of a surgical site infection (SSI) can vary depending on the severity and type of infection. Common signs include redness and pain around the area of the surgical wound. A cloudy or purulent fluid may drain from the wound, indicating infection. Fever is another common symptom, which may accompany other signs such as increased warmth, swelling, or delayed healing at the surgical site. Additional symptoms may also occur, depending on the nature and extent of the infection.{{cite web | title=Surgical Site Infection Basics | website=Surgical Site Infections (SSI) | date=28 Jun 2024 | url=https://www.cdc.gov/surgical-site-infections/about/index.html | access-date=27 Nov 2024}}

Types

SSIs occur in different areas such as skin, tissue, organs, "implanted material, like a hip replacement".

The Centers for Disease Control and Prevention (CDC) classifies SSIs into three categories: superficial incisional, deep incisional, and organ/space infections.

Superficial incisional infection: involve only the outer layer of skin where the incision was made.
Deep incisional infection: affect deeper tissues beneath the incision, such as muscles and the surrounding connective tissues.
Organ or space infection: occur in internal areas of the body, such as an organ or a cavity between organs, that were involved in the surgical procedure.{{cite web | title=Surgical Site Infections | website=University of Rochester Medical Center | url=https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=134&contentid=144 | access-date=27 Nov 2024}}

Pathogen involving

The microorganisms responsible for surgical site infections (SSIs) are often derived from endogenous flora. The specific pathogens involved typically vary depending on the type of surgical procedure performed. Among the most frequently identified organisms are staphylococcus aureus, coagulase-negative staphylococci, enterococcus faecalis, and escherichia coli. These pathogens reflect the microbiological environment of the surgical field and the body sites exposed during the operation.{{cite journal | last1=Owens | first1=C.D. | last2=Stoessel | first2=K. | title=Surgical site infections: epidemiology, microbiology and prevention | journal=Journal of Hospital Infection | publisher=Elsevier BV | volume=70 | year=2008 | issn=0195-6701 | doi=10.1016/s0195-6701(08)60017-1 | pages=3–10}}

Mortality

SSIs are a significant cause of complications following surgery, contributing to both perioperative morbidity and mortality. These infections are responsible for a large number of healthcare-associated infections globally, including over 2 million cases annually in the United States alone.

Studies

There has been ongoing research on the SSIs, with the National Institute for Health and Care Research (NIHR) Global Research Health Unit on Global Surgery and GlobalSurg Collaborative. Several keypoints have been identified as Low income countries have a disproportionately greater burden of SSIs (with 4 times the burden in children) than other countries and higher rates of antibiotic resistance.{{Cite journal |last=Bhangu |first=Aneel |last2=Ademuyiwa |first2=Adesoji O. |last3=Aguilera |first3=Maria Lorena |last4=Alexander |first4=Philip |last5=Al-Saqqa |first5=Sara W. |last6=Borda-Luque |first6=Giuliano |last7=Costas-Chavarri |first7=Ainhoa |last8=Drake |first8=Thomas M. |last9=Ntirenganya |first9=Faustin |last10=Fitzgerald |first10=J. Edward |last11=Fergusson |first11=Stuart J. |last12=Glasbey |first12=James |last13=Ingabire |first13=JC Allen |last14=Ismaïl |first14=Lawani |last15=Salem |first15=Hosni Khairy |date=2018-05-01 |title=Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study |url=https://www.thelancet.com/journals/lancet/article/PIIS1473-3099(18)30101-4/fulltext?code%5Cu003dlancet-site= |journal=The Lancet Infectious Diseases |language=English |volume=18 |issue=5 |pages=516–525 |doi=10.1016/S1473-3099(18)30101-4 |issn=1473-3099 |pmid=29452941|hdl=10072/391615 |hdl-access=free }}{{Cite journal |last=Drake |first=Thomas M. |last2=Pata |first2=Francesco |last3=Ghosh |first3=Dhruv |last4=Ademuyiwa |first4=Adesoji O. |last5=Arnaud |first5=Alexis |last6=Bhangu |first6=Aneel |last7=Fitzgerald |first7=J. Edward |last8=Glasbey |first8=James |last9=Harrison |first9=Ewen M. |last10=Bhangu |first10=Aneel |last11=Ademuyiwa |first11=Adesoji O. |last12=Aguilera |first12=Maria Lorena |last13=Alexander |first13=Philip |last14=Al-Saqqa |first14=Sara W. |last15=Borda-Luque |first15=Giuliano |date=2020-12-03 |title=Surgical site infection after gastrointestinal surgery in children: an international, multicentre, prospective cohort study |url=https://gh.bmj.com/content/5/12/e003429 |journal=BMJ Global Health |language=en |volume=5 |issue=12 |doi=10.1136/bmjgh-2020-003429 |issn=2059-7908 |pmid=33272940|hdl=2434/896428 |hdl-access=free }} More studies have investigated the role of perioperative high fraction Oxygen and Telemedicine in preventing and improving outcomes of SSIs.{{Cite journal |last=Surgery |first=NIHR Global Health Research Unit on Global |last2=Collaborative |first2=GlobalSurg |year=2023 |title=Use of Telemedicine for Postdischarge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review With Meta-analysis |url=https://journals.lww.com/annalsofsurgery/fulltext/2023/06000/use_of_telemedicine_for_postdischarge_assessment.43.aspx |journal=Annals of Surgery |language=en-US |volume=277 |issue=6 |pages=e1331 |doi=10.1097/SLA.0000000000005506 |issn=0003-4932|hdl=11573/1679578 |hdl-access=free }}{{Cite journal |last=Biccard |first=Bruce M. |last2=Smith |first2=Denton |last3=Peters |first3=Shrikant |last4=Boutall |first4=Adam |last5=Wilson |first5=Graeme |last6=Coetzee |first6=Ettienne |last7=Flint |first7=Margot |last8=Gumede |first8=Simphiwe |last9=Rayamajhi |first9=Shreya |last10=Bannister |first10=Sharon |last11=Daniel |first11=Nonkululo |last12=Fourtounas |first12=Maria |last13=Moore |first13=Rachel |last14=Sentholang |first14=Nnosa |last15=Osayomwanbo |first15=Osaheni |date=2023-09-01 |title=Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries |url=https://www.sciencedirect.com/science/article/pii/S2772609623000862 |journal=BJA Open |volume=7 |pages=100207 |doi=10.1016/j.bjao.2023.100207 |issn=2772-6096|hdl=11585/953624 |hdl-access=free }}

A study conducted by researchers at the University of Washington School of Medicine, published in 2024 and featured by the University of Minnesota{{cite web | title=Many surgical site infections begin with the microbiome | website=UW Medicine | date=11 Apr 2024 | url=https://newsroom.uw.edu/news-releases/many-surgical-site-infections-begin-with-the-microbiome | access-date=27 Nov 2024}} and the American Association for the Advancement of Science,{{cite journal | last1=Long | first1=Dustin R. | last2=Bryson-Cahn | first2=Chloe | last3=Waalkes | first3=Adam | last4=Holmes | first4=Elizabeth A. | last5=Penewit | first5=Kelsi | last6=Tavolaro | first6=Celeste | last7=Bellabarba | first7=Carlo | last8=Zhang | first8=Fangyi | last9=Chan | first9=Jeannie D. | last10=Fang | first10=Ferric C. | last11=Lynch | first11=John B. | last12=Salipante | first12=Stephen J. | title=Contribution of the patient microbiome to surgical site infection and antibiotic prophylaxis failure in spine surgery | journal=Science Translational Medicine | volume=16 | issue=742 | date=10 Apr 2024 | issn=1946-6234 | doi=10.1126/scitranslmed.adk8222 | page=| pmid=38598612 | pmc=11634388 }} and Nature{{cite journal | last1=Hope | first1=Derick | last2=Ampaire | first2=Lucas | last3=Oyet | first3=Caesar | last4=Muwanguzi | first4=Enoch | last5=Twizerimana | first5=Hillary | last6=Apecu | first6=Richard Onyuthi | title=Antimicrobial resistance in pathogenic aerobic bacteria causing surgical site infections in Mbarara regional referral hospital, Southwestern Uganda | journal=Scientific Reports | publisher=Springer Science and Business Media LLC | volume=9 | issue=1 | date=21 Nov 2019 | issn=2045-2322 | doi=10.1038/s41598-019-53712-2 | doi-access=free | page=17299| bibcode=2019NatSR...917299H | pmc=6872727 }} involved 210 adult patients undergoing spinal fusion surgery and found that most infections following surgery were caused by bacteria already present on the patients' skin.{{cite web | title=Study: Pathogens that cause surgical infections may be coming from patients' skin | website=HealthLeaders Media | date=12 Apr 2024 | url=https://www.healthleadersmedia.com/clinical-care/study-pathogens-cause-surgical-infections-may-be-coming-patients-skin | access-date=27 Nov 2024}}

The researchers aimed to understand why surgical site infections (SSIs), which occur in about 1 in 30 surgeries, have not decreased despite infection prevention measures. They analyzed preoperative patient microbiomes and postoperative SSI samples using genomic analysis.{{cite web | last1=Dall | first1=Chris | title=Study: Pathogens that cause surgical infections may be coming from patients' skin | website=CIDRAP | date=11 Apr 2024 | url=https://www.cidrap.umn.edu/antimicrobial-stewardship/study-pathogens-cause-surgical-infections-may-be-coming-patients-skin | access-date=27 Nov 2024}}

Of the 210 patients, 14 (6.8%) developed SSIs. Skin, nasal, and rectal samples were taken before surgery from most patients. Whole genome sequencing of 22 SSI samples revealed that 86% were similar to bacterial strains found on the patients' skin before surgery. Further analysis of 59 additional SSIs in the same hospital showed no common bacterial strains, suggesting that the infections were not linked to external hospital sources.

= Global Surgical-Site Infection score =

A ‘Global Surgical-Site Infection’ score was published by NIHR Global Research Health Unit on Global Surgery and GlobalSurg Collaborative that allows the SSIs risk prediction with perioperative variables.{{Cite journal |last=NIHR Global Research Health Unit on Global Surgery and GlobalSurg Collaborative |date=2024-06-01 |title=Development and external validation of the ‘Global Surgical-Site Infection’ (GloSSI) predictive model in adult patients undergoing gastrointestinal surgery |url=https://academic.oup.com/bjs/article/111/6/znae129/7696992 |journal=British Journal of Surgery |volume=111 |issue=6 |pages=znae129 |doi=10.1093/bjs/znae129 |issn=1365-2168}}