I founded and am now the CEO World Surgical Infection Society, an international organization whose mission is to reduce the burden of infections caused by hospital care. Our current focus is on reducing the burden of surgical site infections following cesarean section in eastern and southern Africa. We are collaborating with WHO in a guideline on prevention of surgical site infections.
Postoperative infections at the site of an operation often have serious consequences. This is particularly true of postoperative intra-abdominal infections, in which the identified organisms are typically multiresistant Gram negatives, Gram positives, and yeast. There is considerable evidence that the adequacy of empiric therapy will have a substantial impact on the outcome. Complicated intra-abdominal infections include a wide range of infectious processes and are an important cause of healthcare-associated infection. Common sources of infection are biliary obstruction, gallbladder, gastroduodenal, appendiceal or small and large bowel perforations. For severely ill patients, those with peritonitis and those with sepsis syndromes, patient outcomes in complicated intra-abdominal infections are particularly poor, with high mortality rates. Intra-abdominal infections can be community-acquired or hospital-acquired and are often polymicrobial; the most common pathogens are Escherichia coli, Klebsiella spp. and Pseudomonasspp. Other Gram-negative pathogens include Proteus mirabilis, Enterobacter spp.,Bacteroides spp., which are isolated in > 80% of patients with distal bowel infection sources. Streptococcus spp. are the most commonly isolated Gram-positive pathogens. Optimal management of these patients involves a combination of source control and adjunctive broad-spectrum antimicrobial therapy. In this lecture, professor Joseph S. Solomkin reviews the clinical and epidemiological impact of resistance in surgical patients, focusing on complicated intra-abdominal infections and the factors that can limit the consequences of the different types of antimicrobial resistance in these patients.
Published
Sep 2018
In 1973, Nichols and colleagues demonstrated that the addition of preoperative oral antibiotic bowel preparation (OABP) to the mechanical bowel preparation (MBP) was associated with a lower risk of wound infection after colorectal surgery. Since then, evidence for different methods of preoperative bowel preparation on postoperative outcomes, especially SSIs, anastomotic leak, postoperative ileus, sepsis, readmission, reoperation, mortality and length of hospital stay, has been equivocal. Existing reports have evaluated the use of MBP and OABP, alone or in combination, relative to no bowel preparation, with limited data comparing the utility of each component of bowel preparation. A 2011 Cochrane review comparing MBP with no bowel preparation found no significant difference in the primary outcome of anastomotic leak, and no significant difference in the secondary outcomes of mortality, peritonitis, reoperation, wound infection and infectious extra‐abdominal complications. Recent randomized controlled trials, have similarly demonstrated that MBP alone does not improve postoperative outcomes. In contrast, recent studies, including RCTs and meta‐analyses, have demonstrated a clear reduction in SSI with MBP plus OABP compared with no bowel preparation. In this lecture, professor Joseph S. Solomkin reviews the current results regarding the mechanical bowel preparation and surgical site infection, and gives some final recommendations on this controversial topic.
Published
Sep 2018
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