Carriage of Extended-spectrum Beta-lactamase-producing Enterobacteriaceae and the Risk of Surgical Site Infection After Colorectal Surgery: A Prospective Cohort Study.

Autor:	Dubinsky-Pertzov B; National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Israel., Temkin E; National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Israel., Harbarth S; Infection Control Program, Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Center, Switzerland., Fankhauser-Rodriguez C; Infection Control Program, Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Center, Switzerland., Carevic B; Department of Hospital Epidemiology, Clinical Center of Serbia, Belgrade., Radovanovic I; Department of Hospital Epidemiology, Clinical Center of Serbia, Belgrade., Ris F; Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland., Kariv Y; Department of Surgery, Tel Aviv Sourasky Medical Center, Israel., Buchs NC; Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland., Schiffer E; Department of Anesthesiology, Geneva University Hospitals and Faculty of Medicine, Switzerland., Cohen Percia S; National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Israel., Nutman A; National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Israel., Fallach N; National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Israel., Klausner J; Sackler Faculty of Medicine, Tel Aviv University, Israel.; Department of Surgery, Tel Aviv Sourasky Medical Center, Israel., Carmeli Y; National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Israel.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2019 May 02; Vol. 68 (10), pp. 1699-1704.
DOI:	10.1093/cid/ciy768
Abstrakt:	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. (© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu