Copyright
©The Author(s) 2023.
World J Gastrointest Surg. Dec 27, 2023; 15(12): 2674-2692
Published online Dec 27, 2023. doi: 10.4240/wjgs.v15.i12.2674
Published online Dec 27, 2023. doi: 10.4240/wjgs.v15.i12.2674
Distinction | Superficial incisional SSI | Deep incisional SSI | Organ/space infections | |
Localization | Subcutaneous tissue and/or skin | Fascial and muscle layers | Organ manipulated during surgery | |
Timing | Within 30 d post-surgery | Within 30 or 90 d post-surgery/1 yr (implant in place) | ||
Diagnosis at least one of the following | ||||
Pain | Yes | Yes | Yes | |
Swelling | Yes | Inconstant | Inconstant | |
Erythema or heat | Yes | Inconstant | Inconstant | |
Purulent drainage | Yes (superficial) | Yes (from deep incision) | No | |
Wound dehiscence | Yes (superficial) | Yes | No | |
Culture | Yes | Recommended | Recommended | |
Abscess | No | Yes | Yes | |
Fever (temperature > 38 °C) | Inconstant | Yes | Yes |
Continent | Country | Period | SSIs incidence | Ref. |
Africa | Cameroon | 2013-2014 | Overall: 15.25% | [23] |
Egypt | 2013-2017 | CSEC: 5.34% | [24] | |
2016-2018 | Overall: 2.3%, CSEC: 2.8% | [25] | ||
Ethiopia | 2015 | Overall: 19.1% | [26] | |
2019 | Overall: 21.1%; ABDS: 49.06% | [27] | ||
Ghana | 2017-2018 | Overall: 10%; APPY: 13.4%; GAST: 12.7%; HER: 5.9%; ABDS: 13.7% | [28] | |
Kenya | 2015 | CSEC: 4% | [29] | |
Morocco | 2018-2019 | Overall: 6.3% | [30] | |
Rwanda | 2019-2020 | CSEC: 5.7% | [31] | |
Sierra Leone | 2019-2020 | CSEC: 10.3%; HER: 1.2% | [32] | |
2021 | Overall: 11.5%; ABDS: 79.5% | [33] | ||
South Africa | 2017 | APPY: 25% | [34] | |
Tanzania | 2009-2010 | Overall: 26%; APPY: 15%; CHOL: 14.3%; XLAP: 27.9% | [35] | |
2018-2020 | CSEC: 14% | [36] | ||
Tunisia | 2015-2016 | CSEC: 5% | [37,38] | |
2015 | APPY: 9.8%; CHOL: 1.1%; BILI: 13.6% | |||
America | Brazil | 2008-2011 | Overall: 3.4% | [39] |
2008-2018 | BAR open: 3%; BAR VLP: 0.5% | [40] | ||
Canada | 2015-2016 | CSEC: 5.9% | [41] | |
2015-2019 | COLO: 10.28%; BILI: 16.13% | [42] | ||
Colombia | 2008-2010 | APPY: 3.9%; HYST: 5.5%; SPLE: 4.5%; CHOL: 3% | [43] | |
2022 | HER: 7.9%; CHOL: 8.3%; CSEC: 22.2% | [44] | ||
Cuba | 2017-2018 | APPY: 13.8%; HER: 5.7% | [45] | |
Ecuador | 2018 | CSEC: 1.35% | [46] | |
Honduras | 2017-2018 | CSEC: 5.1% | [47] | |
Mexico | 2011-2012 | Overall: 12.1%; COLO: 5.2%; APPY: 4.9%; CHOL: 0.8%; HER: 0.9% | [48] | |
2013-2015 | CHOL: 5.5% | [49] | ||
Peru | 2005-2010 | APPY: 2.9%; CHOL: 2.8%; CSEC: 2.2% | [50] | |
2015-2018 | CSEC: 2.4% | [51] | ||
2019-2020 | CSEC: 0.88%; CHOL: 0.18%; HER: 0.38% | [52] | ||
Uruguay | 2012-2013 | APPY: 3.2%; CHOL: 6.2%; COLO: 15.4% | [53] | |
2021 | CSEC: 1.74%; CHOL open: 1.85%; CHOL VLP: 0.23% | [54] | ||
Venezuela | 2019-2021 | Overall: 9.7%; APPY: 10.42%; BILI 3.79% | [55] | |
United States | 2011-2014 | Overall: 0.9%; COLO: 3.99%-9.47%; CHOLO: 0.23%-1.72%; HER: 0.74%-5.25%; REC: 3.47%-26.67%; SB: 3.44%-6.75% | [16,17,56] | |
2015-2019 | COLO: 6.82%; BILI: 12.72% | [42] | ||
2016-2017 | CHOL: 0.96% | [57] | ||
Asia | China | 2020 | ABDS: 2.9%; COLO 7.1% | [58,59] |
2018 | GAST: 5.2% | [60] | ||
2017-2020 | CSEC: 23.30% | [61] | ||
India | 2011-2017 | Appendix: 35.3% | [62] | |
2016 | CSEC: 10.3% | [63] | ||
2005-2011 | XLAP: 6%; HER: 3.8% | [64] | ||
Iran | 2018 | Overall: 0.29% | [65] | |
2021 | Overall: 5.2% surveillance | [66] | ||
Japan | 2008-2010 | COLO: 15%; REC: 17.8% | [67,68] | |
2009-2019 | APPY: VLP 4.19%, OPEN 6.60% | [69] | ||
CHOL: VLP 1.91%, OPEN 7.42% | ||||
SB: VLP 8%, OPEN 15% | ||||
COLO: VLP 7.27%, OPEN 15.5% | ||||
REC: VLP 11.3%, OPEN 8.8% | ||||
Kuwait | 2016 | SB: 6.5%; GAST: 0.7% | [70] | |
Nepal | 2019 | CSEC: 8.54% | [71] | |
Pakistan | 2014-2019 | BILI: 40% | [72] | |
2016-2017 | APPY: 32.7%; CHOLO: 20.7%; HER: 37.6% | [73] | ||
Philippines | 2018-2019 | Overall: 9.7% | [74] | |
Republic of Korea | 2008-2012 | GAST: 3.12% | [75] | |
Saudi Arabia | 2016 | Overall: 16.3%; open surgery: 34.8%; VLP surgery: 3.5% | [76] | |
Taiwan | 2021 | Overall: 4.0%; regional hospital: 4.7% medical center | [77] | |
Thailand | 2007-2016 | Overall: 2.98% | [78] | |
Turkey | 2005-2011 | CHOL: 1.3%; COLO: 11.4%; CSEC: 3%; GAST: 4.3%; HYST: 3.1%; SPLE: 5%; XLAP: 2.6% | [79] | |
United Arab Emirates | 2016-2017 | CSEC: 1.4% | [80] | |
Europe | Austria | 2018-2020 | CHOL: 0.4%; COLO: 3.6%; CSEC: 0.5% | [19] |
England | 2017-2022 | HYST: 1.7%; BILI: 15.4%; CHOL: 9.7%; GAST: 1.9%; COLO: 8.6% | [81] | |
Estonia | 2018-2020 | CSEC: 2.0% | [19] | |
France | 2018-2020 | CHOL: 0.7%; CSEC: 1.7% | [19] | |
Germany | 2018-2020 | CHOL: 0.9%; COLO: 8.9%; CSEC: 0.6% | [19] | |
Hungary | 2018-2020 | CHOL: 1.1%; COLO: 10.4%; CSEC: 1.3% | [19] | |
Italy | 2018-2020 | CHOL: 0.7%; COLO: 5.9%; CSEC: 0.7% | [19] | |
Lithuania | 2018-2020 | CHOL: 0.2%; COLO: 10.6%; CSEC: 0.6% | [19] | |
Malta | 2018-2020 | COLO: 26.8% | [19] | |
Netherlands | 2018-2020 | CHOL: 2.6%; COLO: 16.1%; CSEC: 1.5% | [19] | |
Norway | 2018-2020 | CHOL: 2.8%; COLO: 11.7%; CSEC: 3.6% | [19] | |
Portugal | 2018-2020 | CHOL: 2.3%; COLO: 14.5%; CSEC: 1.6% | [19] | |
Slovakia | 2018-2020 | CHOL: 2.9% | [19] | |
Spain | 2016 | COLO: 10.6% | [82] | |
2013-2016 | REC: 11.9% | [83] | ||
2009-2016 | CHOL: 1.96% | [84] | ||
Switzerland | 2017-2018 | APPY: 3.1%; CHOL: 2.2%; HER: 0.9%; COLO: 13.5%; REC: 17.7%; GAST: 3.1%; CSEC: 1.8% | [85] | |
Oceania | Australia | 2002-2013 | Overall: 2.8% | [86] |
Microorganism | Type of surgery | ||||
Laparoscopic CHOL | Open CHOL | Laparoscopic COLO | Open COLO | CSEC | |
Gram-positive cocci | 52.9 | 39 | 34.8 | 70.4 | 78.8 |
Staphylococcus aureus | 23.9 | 7.6 | 4.3 | 25 | 38.4 |
Coagulase-negative staphylococci | 9.2 | 6.2 | 2.2 | 27 | 22.6 |
Enterococcus species | 11.1 | 18.9 | 24.5 | 9.3 | 5.6 |
Streptococcus species | 4.8 | 1.9 | 2.3 | 3.7 | 5.7 |
Other Gram-positive cocci | 3.9 | 4.4 | 1.4 | 5.4 | 6.5 |
Gram-positive bacilli | 1.5 | 0.8 | 0.1 | 2 | 2.7 |
Gram-negative bacilli Enterobacterales | 27.5 | 44.4 | 48.7 | 18.3 | 10.6 |
Escherichia coli | 13.2 | 21.7 | 30.4 | 6.2 | 3.5 |
Citrobacter species | 0.5 | 2.4 | 1.1 | 0.7 | 0.4 |
Enterobacter species | 2.3 | 5.6 | 5.5 | 3.3 | 2.8 |
Klebsiella species | 5 | 9.8 | 6.2 | 2.1 | 1.4 |
Proteus species | 3.5 | 2.1 | 2.1 | 3.8 | 1.3 |
Serratia species | 1.1 | 0.3 | 0.9 | 1 | 0.8 |
Other Enterobacteriaceae | 2.1 | 2.5 | 2.5 | 1.1 | 0.4 |
Gram-negative nonfermentative bacilli | 4.2 | 2.1 | 6 | 3.8 | 3.3 |
Acinetobacter species | 0.5 | 0.3 | 0.4 | 0.6 | 0.6 |
Hemophilus species | 0.2 | 0.1 | 0 | 0 | 0.1 |
Pseudomonas aeruginosa | 2.1 | 0.9 | 5.3 | 2.9 | 1.6 |
Pseudomonadaceae family, other | 0.2 | 0 | 0 | 0.2 | 0.6 |
Stenotrophomonas maltophilia | 0 | 0.3 | 0.1 | 0.1 | 0.3 |
Other Gram-negative nonfermentative bacilli | 1.4 | 0.5 | 0.2 | 0.1 | 0 |
Anaerobes | 12 | 8.7 | 6.3 | 4.8 | 3.8 |
Bacteroides species | 1.8 | 1.2 | 4.4 | 0.2 | 0.1 |
Other anaerobes | 10.2 | 7.5 | 2 | 4.6 | 3.7 |
Other bacteria | 1.8 | 3.5 | 1 | 0.4 | 0.6 |
Fungi, parasites | 0.2 | 1.5 | 3.2 | 0.3 | 0.1 |
Candida species | 0.2 | 1.5 | 3.2 | 0.3 | 0.1 |
Other fungi or parasites | 0 | 0 | 0 | 0 | 0 |
Study name | ClinicalTrial.gov identifier | Design | Status | Type of surgery | Intervention(s) | Country |
Iodine-Povidone Alcohol Compared to Chlorhexidine Alcohol as Preoperative Antiseptics in Major Abdominal Elective Clean Contaminated Surgery | NCT03859908 | Single blind RCT | Terminated | Elective surgery categorized as clean contaminated surgery | Drug: Iodine povacrylex/isopropyl alcohol | El Salvador |
Drug: Chlorhexidine gluconate/isopropyl alcohol | ||||||
Examination of the Effect of Skin Antisepsis with Pre-heated Povidone Iodine on Surgical Site Infections: A Quasi-Experimental Study | NCT04969302 | Single blind RCT | Completed | NS | Experimental: Povidone-iodine will heat to 37 °C using a gel warmer | Greece |
Control: Povidone-iodine will heat to 20 °C using a gel warmer | ||||||
Study to Assess the Safety & Efficacy of Oral Ciprodiazole Versus Currently Used Ciprofloxacin & Metronidazole (CIPRO-001) | NCT05863832 | Open label RCT | Recruiting | Pelvi-abdominal surgery | Experimental | Egypt |
Ciprodiazole | ||||||
Active comparator: Ciprofloxacin 500 mg | ||||||
PVP Iodine vs Chlorhexidine in Alcohol for Disinfection of the Surgical Site (PICASSo) | NCT03685604 | Single blind RCT | Completed | Colorectal surgery, cholecystectomy, herniotomy, appendectomy and bariatric surgery | Active comparator: Braunoderm® | Switzerland |
Comparator | ||||||
Softasept® | ||||||
Delafloxacin IV and OS Administration Compared to Best Available Therapy in Patients with Surgical Site Infections (DRESS) | NCT04042077 | Single blind RCT | Terminated | Abdominal surgery | Drug: Delafloxacin | Rome |
Drug: Vancomycin | ||||||
Drug: Linezolid | ||||||
Drug: Piperacillin/tazobactam | ||||||
Drug: Tigecycline | ||||||
A Randomized, Blinded, Placebo and Standard of Care Controlled Efficacy, Safety, and Tolerability Study of up to 20 mL of DFA-02 in Patients Undergoing Abdominal Surgery | NCT01888367 | Triple blind RCT | Completed | Abdominal surgery | Drug: DFA-02 Antibiotic Gel | United States |
Drug: DFA-02 Placebo Gel | ||||||
Reduction of Postoperative Wound Infections by Antiseptica? (RECIPE) | NCT04055233 | Double blind RCT | Completed | Laparotomy for visceral surgery | Drug: Polihexanide; Serasept | Germany |
Drug: NaCl; saline | ||||||
Study of Chlorhexidine Gluconate as a Preoperative Antisepsis (CHG) | NCT01495117 | Quadruple blind RCT | Completed | Resection surgery (clean-contaminated open surgery) | Drug: Povidone-Iodine | Republic of Korea |
Drug: Chlorhexidine gluconate | ||||||
A Randomized Controlled Trial of 2% Chlorhexidine Gluconate Skin Preparation Cloths for the Prevention of Post-Operative Surgical Site Infections in Colorectal Patients | NCT02385708 | Open label RCT | Completed | Colorectal surgery | Drug: 2% chlorohexidine gluconate standard of care | United States |
Drug: 2% chlorohexidine gluconate chin to toe | ||||||
Effect of Peritoneal Lavage with Clindamycin-gentamicin Solution on Postoperative Colorectal Cancer Infection in Elective Surgery | NCT01378832 | Open label RCT | Completed | Colorectal surgery | Procedure: Intra-peritoneal antibiotic lavage | No location data |
Collagen-Gentamicin Implant in the Treatment of Contaminated Surgical Abdominal Wounds - A Randomized Controlled Trial | NCT00977405 | Double blind RCT | Terminated | Abdominal surgery | Device: Collatamp gentamicin implant | Singapore |
CLinical Evaluation of Adults UNdergoing Elective Surgery Utilizing Intraoperative Incisional Wound Irrigation: A Randomized Controlled Trial (CLEAN Wound) | NCT04548661 | Double blind RCT | Not yet recruiting | Laparotomy (clean-contaminated or contaminated incision). Laparoscopy (clean-contaminated or contaminated incision) | Procedure: Intraoperative incisional wound irrigation with povidone-iodine solution | Canada |
Procedure: Intraoperative incisional wound irrigation with saline | ||||||
Randomized Controlled Trial to Evaluate the Optimal Timing of Surgical Antimicrobial Prophylaxis | NCT01790529 | Quadruple blind RCT | Completed | Colorectal surgery | Procedure: Cefuroxime + metronidazole 75 to 30 min prior to skin incision | Switzerland |
Procedure: Cefuroxime + metronidazole within 30 min prior to skin incision) | ||||||
A Pilot Clinical Evaluation of the Antimicrobial Effectiveness of Topically Applied ZuraPrep™ | NCT02221232 | Open label pilot study | Terminated | NS | Drug: Chloraprep | United States |
Drug: ZuraPrep | ||||||
Drug: ZuraPrep Vehicle | ||||||
ROSSINI 2 - Reduction of Surgical Site Infection Using Several Novel Interventions (ROSSINI 2) | NCT03838575 | Double blind RCT | Recruiting | Colorectal, hepatobiliary, upper GI, urological, vascular, or gynecological | Drug: 2% alcoholic chlorhexidine skin prep (SKIN PREP) | United Kingdom |
Device: Iodophor Antimicrobial Incise Drapes (DRAPE) | ||||||
Device: Gentamicin-impregnated implants/sponges (SPONGE) | ||||||
Other: None (control) | ||||||
D-PLEX 311: Safety and Efficacy of D-PLEX in the Prevention of Post Abdominal Surgery Incisional Infection (SHIELD I) | NCT04233424 | Triple blind RCT | Completed | Elective colorectal surgery | Drug: D-PLEX (new formulation of extended release of doxycycline) | United States |
Other: SoC | ||||||
D-PLEX 312 - Safety and Efficacy of D-PLEX in the Prevention of Post Abdominal Surgery Incisional Infection (SHIELD II) | NCT04411199 | Triple blind RCT | Recruiting | Elective colorectal surgery | Drug: D-PLEX + SoC | United States, Hungary, Serbia, Poland, Israel |
Other: SoC | ||||||
Abdomen Closure Using Triclosan Coated Absorbable Suture vs Uncoated Sutures of the Same Base Material | NCT01620294 | Double blind RCT | Completed | Elective colorectal surgery | Procedure: Abdominal wall closure | Hungary |
Procedure: Surgical site infection | ||||||
Prophylaxis of Surgical Wound Infection with Topical Antibiotics | NCT04476212 | Triple blind RCT | Recruiting | Elective abdominal wall surgery | Drug: Amoxicillin-clavulanate for topical prophylaxis | Spain |
Elective and emergency colorectal surgery | No intervention: Control | |||||
D-PLEX 310: Safety and Efficacy of D-PLEX in the Prevention of Post Abdominal Surgery Incisional Infection | NCT03633123 | Single blind RCT | Completed | Elective colorectal surgery | Drug: D_PLEX | Israel |
Other: SoC | ||||||
Antibiotic Prophylaxis in the Prevention of Surgical Site Infections After Selected Urgent Abdominal Surgical Procedures | NCT01524081 | Double blind RCT | Completed | Emergent surgery for: Acute appendicitis/perforated gastric or duodenal ulcer/small bowel obstruction | Drug: Metronidazole, cefuroxime | Czech Republic |
Drug: Amoxicillin (+ clavulanic acid) and fluconazole | ||||||
Drug: Placebo | ||||||
Drug: Placebo | ||||||
Study the Efficacy of Topical Antibiotherapy in the Prophylaxis of Incisional Surgical Infection in Colorectal Surgery (PROTOP) | NCT03574090 | Triple blind RCT | Completed | Colorectal surgery | Drug: Amoxicillin clavulanate | Spain |
Drug: Physiological saline | ||||||
Parenteral Antibiotics Compared to Combination of Oral and Parenteral Antibiotics in Colorectal Surgery Prophylaxis (ORALEV) | NCT02505581 | Quadruple blind RCT | Completed | Colorectal surgery | Drug: Extra dosage - cefuroxime (750 mg) intravenous | Spain |
Drug: Ciprofloxacin 750 mg oral | ||||||
Drug: Metronidazole 250 mg oral | ||||||
Drug: Cefuroxime 1.5 g intravenous | ||||||
Drug: Metronidazole 1 g intravenous | ||||||
Impact of Triclosan-coated Suture on Surgical Site Infection After Colorectal Surgery | NCT01869257 | Single blind RCT | Completed | Colorectal surgery | Device: Triclosan coated suture | Italy |
Device: Regular suture | ||||||
Intravenous Versus Combined Oral and Intravenous Antimicrobial Prophylaxis for the Prevention of Surgical Site Infection in Elective Colorectal Surgery (COMBINE) | NCT02618720 | Double blind RCT | Completed | Elective colorectal surgery | Drug: Ornidazole | France |
Drug: Placebo | ||||||
Prophylactic Effect Preoperative Antibiotics with Mechanical Bowel Preparation in SSIs | NCT03856671 | Open label RCT | Completed | Laparoscopic colorectal surgery | Drug: Neomycin, metronidazole | China |
Frequency of Surgical Site Infection in Abdominal Hernia with Gentamycin Spray on Mesh Versus no Spray | NCT04164524 | Case-Control trial | Completed | Elective surgery; Para umbilical hernia, umbilical and epigastric hernia, | Drug: Gentamycin 160 mg spray applied over the mesh | Pakistan |
Antibiotic Instillation in Acute Complex Appendicitis for Prevention of Deep Space Surgical Site Infections | NCT05470517 | Single blind RCT | Recruiting | Appendectomy | Drug: Ceftriaxone | United States |
Procedure: Intra-peritoneal fluid aspiration | ||||||
Prophylaxis of Surgical Wound Infection in Incisional Hernia Repair With Topical Antibiotics (PROTOP-PAR) | NCT05508152 | Triple blind RCT | Recruiting | Elective surgical procedure due to an abdominal wall incisional hernia | Drug: Wound irrigation with amoxicillin-clavulanate in saline solution | Spain |
Drug: Wound irrigation with a saline solution | ||||||
Orally Administered Trimethoprim-sulfamethoxazole and Metronidazole as Prophylaxis of Infection Following Elective Colorectal Surgery | NCT00613769 | Triple blind RCT | Completed | Colorectal surgery | Drug: Trimethoprim-sulfamethoxazole + metronidazole | Sweden |
Drug: Cefuroxime and metronidazole | ||||||
The Effect of Intraoperative Peritoneal Lavage With Super-Oxidized Solution on Surgical Site Infections and Mortality in Patients With Secondary Peritonitis: A Randomized Controlled Trial | NCT05050253 | Open label RCT | Recruiting | Emergency abdominal surgery by laparotomy | Device: Super-oxidized solution | Switzerland |
Device: Ringer’s solution | ||||||
Reducing INfection at the Surgical SitE With Antibiotic Irrigation During Ventral Hernia Repair (RINSE Trial) | NCT03945357 | Open label RCT | Completed | Elective, open ventral hernia repair | Drug: Gemcitabine/clindamycin | United States |
Drug: Normal saline | ||||||
Preoperative Oral Antibiotics With vs Without Mechanical Bowel Preparation to Reduce Surgical Site Infections Following Colonic Resection: an International Randomized Controlled Trial. (ORALEV2) | NCT04161599 | Single blind RCT | Recruiting | Colectomy | Drug: Cefuroxime (750 mg) intravenous | China |
Drug: Cefuroxime 750 mg oral | Italy | |||||
Drug: Metronidazole 250 mg oral tablet | Spain | |||||
Drug: Metronidazole 1 g intravenous | Russia | |||||
Drug: Cefuroxime 1.5 g intravenous | Greece | |||||
Drug: Sodium picosulfate, light magnesium oxide, anhydrous citric acid 10 mg/3.5 g/10.97 g oral | United Kingdom | |||||
Standard Versus Pre-emptive Antibiotic Treatment to Reduce the Rate of Infectious Outcomes After Whipple’s Procedure (SPARROW): a Multicenter, Randomized Controlled Trial | NCT05784311 | Open label RCT | No yet recruiting | Elective pancreatoduodenectomy | Drug: Cefuroxime | Netherlands |
Drug: Metronidazole |
- Citation: Fiore M, Corrente A, Di Franco S, Alfieri A, Pace MC, Martora F, Petrou S, Mauriello C, Leone S. Antimicrobial approach of abdominal post-surgical infections. World J Gastrointest Surg 2023; 15(12): 2674-2692
- URL: https://www.wjgnet.com/1948-9366/full/v15/i12/2674.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v15.i12.2674