Which pathogens cause surgical site infection in visceral surgery?

Background Surgical site infection (SSI) is a common complication in visceral surgery. Pathogens causing SSI vary depending on the type of surgery.

Methods Within the scope of the RECIPE trial we analyzed the pathogens cultured in intraoperative subcutaneous swabs and in swabs from postoperatively openend wounds in patients with SSI in a single-centre, prospective, randomized-controlled trial. Definition of SSI complied with the criteria of the Centers for Disease Control and Prevention. Follow-up was defined as 30 days postoperatively.

Results Overall rate of SSI was 28.2 % in 393 patients. Colorectal surgery was performed in 68.2 % of all elective laparotomies. Pathogens were more often detected in intraoperative subcutaneous swabs in patients who developed SSI than in patients who did not develop SSI (64.4 % vs. 38.0 %; p< 0.001). The number of pathogens from intraoperative swabs was associated with the occurrence of SSI (two to three pathogens per swab: 25.6 % vs. 8.8 %; p< 0.001). The same species in the intraoperative swab and in the swab from opened wounds was detected in 50 % of cases. A higher rate of Enterococcus faecium was found in patients with anemia vs. without anemia (9.2 % vs. 2.3 %; p = 0.006), in patients who smoked vs. non-smokers (11.8 % vs. 3.6 %; p = 0.008) and in underweight patients vs. normal vs. overweight patients (20.0 % vs. 5.8 % vs. 3.4 %; p = 0.023).

Conclusions SSI occurred more often in contaminated abdominal wall with pathogens. More efforts are justified to reduce intraoperative contamination of the abdominal wall. Perioperative antibiotic prophylaxis should be tailored to the predominant local pathogens and resistance.

Abb 1. Pathogens in Intraoperative Swabs of Abdominal Wall and in Postoperatively Opened Wound

Abb 2. Top Ten Pathogens in Intraoperative Swabs of Abdominal Wall and in Postoperatively Opened Wounds

Publication History

Article published online:
07 September 2021