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Current outcomes and predictors of treatment failure in patients with surgical site infection after elective colorectal surgery. A multicentre prospective cohort study

2017; Elsevier BV; Volume: 74; Issue: 6 Linguagem: Inglês

10.1016/j.jinf.2017.03.002

1532-2742

Aina Gomila-Grange, Josep M. Badía, Jordi Carratalà, Xavier Serra‐Aracil, Evelyn Shaw, Vicens Díaz-Brito, Antoni Castro, E. Espejo, C. Nicolás, Marta Piriz, Montserrat Brugués, Josefina Obradors, Ana Lérida, Jordi Cuquet, Enrique Limón Cáceres, Francesc Gudiol, Miquel Pujol,

Appendicitis Diagnosis and Management

Objective To determine current outcomes and predictors of treatment failure among patients with surgical site infection (SSI) after colorectal surgery. Methods A multicentre observational prospective cohort study of adults undergoing elective colorectal surgery in 10 Spanish hospitals (2011–2014). Treatment failure was defined as persistence of signs/symptoms of SSI or death at 30 days post-surgery. Results Of 3701 patients, 669 (18.1%) developed SSI; 336 (9.1%) were organ-space infections. Among patients with organ-space SSI, 81.2% required source control: 60.4% reoperation and 20.8% percutaneous/transrectal drainage. Overall treatment failure rate was 21.7%: 9% in incisional SSIs and 34.2% in organ-space SSIs (p < 0.001). Median length of stay was 15 days (IQR 9–22) for incisional SSIs and 24 days (IQR 17–35) for organ-space SSIs (p < 0.001). One hundred and twenty-seven patients (19%) required readmission and 35 patients died (5.2%). Risk factors for treatment failure among patients with organ-space SSI were age ≥65 years (OR 1.83, 95% CI: 1.07–1.83), laparoscopy (OR 1.7, 95% CI: 1.06–2.77), and reoperation (OR 2.8, 95% CI: 1.7–4.6). Conclusions Rates of SSI and treatment failure in organ-space SSI after elective colorectal surgery are notably high. Careful attention should be paid to older patients with previous laparoscopy requiring reoperation for organ-space SSI, so that treatment failure can be identified early.