Control measures to prevent surgical site infection following gastrointestinal procedures in adults
- Deverick J Anderson, MD, MPH
Deverick J Anderson, MD, MPH
- Associate Professor of Medicine
- Duke University Medical Center
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
The rate of surgical site infections (SSIs) is low for most surgical procedures. Because of the relatively large surgical volume in many community hospitals, SSIs are the most common healthcare-associated infection . The United States Centers for Disease Control and Prevention has developed criteria that define SSI as infection related to an operative procedure that occurs at or near the surgical incision within 30 days of the procedure or within 90 days if prosthetic material is implanted at surgery . SSIs are often localized to the incision site but can also extend into deeper adjacent structures.
Gastrointestinal procedures are among the highest risk procedures for SSI due to the presence of intraluminal bacteria. According to data published by the National Healthcare Safety Network, rates of SSI following bile duct, liver, or pancreatic surgery are as high as 10 per 100 procedures. Rates of SSI following colon surgery are approximately 5 per 100 procedures, and rates of SSI following gallbladder surgery are 0.7 per 100 procedures .
Issues related to prevention of SSI following gastrointestinal procedures will be reviewed here. Issues related to epidemiology of SSI and general principles of SSI prevention are discussed further separately. (See "Epidemiology of surgical site infection in adults" and "Antimicrobial prophylaxis for prevention of surgical site infection in adults" and "Overview of control measures for prevention of surgical site infection in adults".)
There are two key components of antimicrobial prophylaxis for prevention of surgical site infection (SSI) following gastrointestinal procedures: antibiotic selection and timing of administration (to optimize tissue concentration at the time of surgery). The choice of agents depends on the type of procedure, as discussed in the following sections (table 1). Timing of administration is discussed separately. (See "Antimicrobial prophylaxis for prevention of surgical site infection in adults", section on 'Timing'.)
Gastroduodenal procedures — Antimicrobial prophylaxis with cefazolin is warranted for patients undergoing clean-contaminated procedures during which the lumen of the intestinal tract is entered [4,5]. These include ulcer resection, carcinoma resection, perforation repair, gastric outlet stricture repair, percutaneous endoscopic gastrostomy (PEG) insertion, pancreaticoduodenectomy (Whipple procedure), and bariatric surgical procedures. (See "Partial gastrectomy and gastrointestinal reconstruction" and "Total gastrectomy and gastrointestinal reconstruction" and "Gastrostomy tubes: Placement and routine care".)
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