Journal Article

Carriage of Extended-spectrum Beta-lactamase–producing Enterobacteriaceae and the Risk of Surgical Site Infection After Colorectal Surgery

Dubinsky-Pertzov, Biana, Ris, Frederic, Harbarth, Stephan, Carmeli, Yehuda, Percia, Shimrit Cohen, Carevic, Biljana, Nutman, Amir, Klausner, Joseph, Temkin, Elizabeth, Fankhauser-Rodriguez, Carolina, Radovanovic, Ivana, Buchs, Nicolas C., Fallach, Noga, Schiffer, Eduardo, Kariv, Yehuda

2019

Overview

Abstract Background Antibiotic prophylaxis that covers enteric pathogens is essential in preventing surgical site infections (SSIs) after colorectal surgery. Current prophylaxis regimens do not cover extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-PE). We aimed to determine whether the risk of SSI following colorectal surgery is higher in ESBL-PE carriers than in noncarriers. Methods We conducted a prospective cohort study of patients who underwent elective colorectal surgery in 3 hospitals in Israel, Switzerland, and Serbia between 2012 and 2017. We included patients who were aged ≥18 years, were screened for ESBL-PE carriage before surgery, received routine prophylaxis with a cephalosporin plus metronidazole, and did not have an infection at the time of surgery. The exposed group was composed of ESBL-PE–positive patients. The unexposed group was a random sample of ESBL-PE–negative patients. We collected data on patient and surgery characteristics and SSI outcomes. We fit logistic mixed effects models with study site as a random effect. Results A total of 3600 patients were screened for ESBL-PE; 13.8% were carriers SSIs occurred in 55/220 carriers (24.8%) and 49/440 noncarriers (11.1%, P < .001). In multivariable analysis, ESBL-PE carriage more than doubled the risk of SSI (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.50–3.71). Carriers had higher risk of deep SSI (OR, 2.25; 95% CI, 1.27–3.99). SSI caused by ESBL-PE occurred in 7.2% of carriers and 1.6% of noncarriers (OR, 4.23; 95% CI, 1.70–10.56). Conclusions ESBL-PE carriers who receive cephalosporin-based prophylaxis are at increased risk of SSI following colorectal surgery. Standard antibiotic prophylaxis administered before colorectal surgery does not cover extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-PE). We found that ESBL-PE carriers have more than twice the risk of noncarriers of developing surgical site infection following colorectal surgery.

• Publisher: Oxford University Press
• Subject: Adult / Aged / Aged, 80 and over / Anti-Bacterial Agents - administration & dosage / Anti-Bacterial Agents - adverse effects / Antibiotic Prophylaxis / ARTICLES AND COMMENTARIES / beta-Lactamases / Carrier State - microbiology / Carrier State - prevention & control / Cephalosporins - administration & dosage / Cephalosporins - adverse effects / Colorectal Surgery - adverse effects / Enterobacteriaceae - drug effects / Enterobacteriaceae - enzymology / Enterobacteriaceae Infections - etiology / Enterobacteriaceae Infections - prevention & control / Feces - microbiology / Female / Humans / Israel / Male / Middle Aged / Prospective Studies / Risk Factors / Serbia / Surgical Wound Infection - microbiology / Surgical Wound Infection - prevention & control / Switzerland