Antibacterial prophylaxis of surgical site infections: an epidemiologist’s view


DOI: https://dx.doi.org/10.18565/epidem.2020.10.1.21-9

Yarovoy S.K., Voskanian Sh.L., Tutelyan А.V., Gladkova L.S.

1) D.D. Pletnev City Clinical Hospital, Moscow Healthcare Department, Moscow, Russia; 2) N.A. Lopatkin Research Institute of Urology and Interventional Radiology, Branch, National Medical Radiology Research Center, Ministry of Health of Russia, Moscow, Russia; 3) Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia; 4) Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Ministry of Health of Russia, Moscow, Russia; 5) I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russia
Objective. To determine the incidence of surgical site infections (SSIs) that can be prevented with ntibacterial drugs for prophylactic purposes.
Materials and methods. A retrospective epidemiological analysis was carried using 37,944 inpatient medical records (Form No. 003/y) of patients who received surgical care in the D.D. Pletnev City Clinical Hospital, Moscow Healthcare Department, in 2015–2017.
Results. A new method for analyzing the incidence of SSIs was considered, by taking into account their preventability with antibiotic prophylaxis. There were 103 (67.8%) SSIs cases recorded in the Departments of Abdominal Surgery. Stratification of SSIs by the National Nosocomial Infection Surveillance (NNIS) risk index established that 88.3% had a risk score of 2 and 3 (48 and 43 cases of SSIs, respectively). Among the SSIs, there was a preponderance of organ/cavity infections (51.5%); superficial and deep incisional SSIs accounted for 34% and 14.5%, respectively. Among patients without a family history of SSIs and those without comorbidities, there were 27 (26%) cases of SSIs (postoperative wound suppurations and diastases, as well as abscesses) that were preventable with perioperative antibiotic prophylaxis. Seventy-six (74%) cases were assigned to a group in which antibiotic prophylaxis could not prevent SSIs: mainly peritonitis and interintestinal anastomosis failure (n = 47 cases). Patients with a NNIS risk score of 2 and 3 were 57%; and those with a risk score of 1 were 43%. Forty-nine (32.2%) cases of SSIs were recorded in the Departments of Urology. SSIs with an NNIS risk index score of 1–3 were distributed evenly and ranged from 32.7 to 34.7%. There were 22 (45%) cases of superficial SSIs and 22 cases of organ/cavity infections. Eleven (22.5%) cases of SSIs, such as postoperative wound suppurations and diastases, were rated as preventable. In patients with severe concomitant diseases, 38 (77.5%) cases were referred to as unpreventable SSIs, such as postoperative pyelonephritis and retroperitoneal abscesses, postoperative wound suppurations and diastases.
Conclusion. The developed method for distributing SSIs into preventable and unpreventable with antibiotic prophylaxis is a criterion for the efficiency of ongoing antibiotic prophylaxis.
Keywords: unpreventable SSIs, preventable SSIs, NNIS risk index, antibacterial prophylaxis, surgical site infections
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About the Autors

Prof. Sergey K. Yarovoy, MD; Leading Researcher, N.A. Lopatkin Research Institute of Urology and Interventional Radiology, Branch, National Medical Radiology Research Center, Ministry of Health of Russia; Clinical Pharmacologist, D.D. Pletnev City Clinical Hospital, Moscow Healthcare Department, Moscow, Russia; e-mail: yarovoy.sk@yandex.ru; ORCID: https://orcid.org/0000-0003-4543-1480; Scopus Author ID: 8302421600
Shushanik L. Voskanian, Junior Researcher, Laboratory of Healthcare-Associated Infections, Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being; Epidemiologist, D.D. Pletnev City Clinical Hospital, Moscow Healthcare Department, Moscow, Russia; e-mail.com: shoushanna@gmail.com; ORCID: https://orcid.org/0000-0003-3815-7153
Prof. Aleksey V. Tutelyan, MD, Corresponding Member of the Russian Academy of Sciences; Head, Laboratory of Healthcare-Associated Infections, Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being; Head, Department of Molecular Immunology, Infectology and Pharmacotherapy, Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Ministry of Health of Russia; Professor, Department of Epidemiology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia; Moscow, Russia; е-mail: bio-tav@yandex.ru; ORCID: http://orcid.org/0000-0002-2706-6689; eLibrary SPIN: 8150-2230
Lilia S. Gladkova, Cand. Med. Sci., Deputy Principal Physician for Sanitary and Epidemiological Issues, D.D. Pletnev City Clinical Hospital, Moscow Healthcare Department, Moscow, Russia; e-mail: liliyagladkova@mail.ru


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