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Surgical site infections and the microbiome: An updated perspective

Published online by Cambridge University Press:  21 February 2019

Richard P. Wenzel
Richard P. Wenzel*
Affiliation:
Internal Medicine Department, Virginia Commonwealth University Health, Richmond, Virginia
*
Author for correspondence: Richard P. Wenzel, Email: [email protected]
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Abstract

Objective:

To address 3 questions: What are the origins of bacteria causing surgical site infections (SSIs)? Is there evidence that the offending bacteria are present at the incision site when surgery begins? What are the estimates of the proportion of SSIs that can be prevented with perioperative control of the microbiome?

Design:

Review of the literature, examining recognized sources of bacteria causing surgical site infections.

Methods:

Specifically, I examined the impact of improved control of the microbiome of the skin and nares on reducing SSIs. The initial effort was to examine the reduction of SSIs linked solely to preoperative skin preparation regimens and to either topical nasal antibiotics or pre- and postoperative nasal antiseptic regimens. To corroborate the concept of the importance of the microbiome, a review of studies showing the relationship of SSIs and marker organisms (eg, Propionobacterium acnes) present at the incision sites was performed. The relationships of SSIs to the microbiome of the skin and nares were summarized.

Results:

Depending on key assumptions, ∼70%–95% of all SSIs arise from the microbiome of the patients’ skin or nares. Data from the studies of marker organisms suggest that the infecting bacteria are present at the incision site at the time of surgery.

Conclusions:

Almost all SSIs arise from the patient’s microbiome. The occurrence of SSIs can be viewed as a perioperative failure to control the microbiome.

Type
Review
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 5 , May 2019 , pp. 590 - 596
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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References

Anderson, DJ. Surgical site infections. Infect Dis Clin N Am 2011;25:135–153.CrossRefGoogle ScholarPubMed
Sender, R, Fuchs, S, Milo, R. Revised estimates for the number of bacteria cells in the body. PLOS Biol 2016;14(8):e1002533. doi: 10.1371/journal.bio.1002533.CrossRefGoogle ScholarPubMed
Grice, EA. The skin microbiome: potential for novel diagnostic and therapeutic approaches to cutaneous disease. Semin Cutan Med Surg 2014;33:98–103.CrossRefGoogle ScholarPubMed
Casadevall, A, Pirofski, L-A. Host–pathogen interactions: basic concepts of microbial commensalism, colonization, infection and disease. Infect Immun 2000;68:654–658.CrossRefGoogle ScholarPubMed
Darouiche, RO, Wall, MJ, Itani, MF, et al. Chlorhexidine–alcohol versus povidone–iodine for surgical site antisepsis. N Engl J Med 2010;362:18–26.CrossRefGoogle ScholarPubMed
Tuuli, MG, Liu, J, Stout, MJ, et al. A randomized trial comparing skin antiseptic agents at cesarean delivery. N Engl J Med 2016;374:647–655.CrossRefGoogle ScholarPubMed
Gravett, A, Sterner, S, Clinton, JE, et al. A trial of povidone–iodine in the prevention of infection in sutured lacerations. Ann Emerg Med 1987;16:167–171.CrossRefGoogle ScholarPubMed
Bode, LGM, Kluytmans, JAW, Heiman, FL, et al. Preventing surgical site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 2010;362:9–17.CrossRefGoogle ScholarPubMed
Mullen, AM, Wieland, HJ, Wieser, ES, et al. Perioperative participation of orthopedic patients and surgical staff in a nasal decolonization intervention to reduce Staphylococcus spp surgical site infections. Am J Infect Control 2017;45:554–555.CrossRefGoogle Scholar
Bostian, PA, Dietz, MJ, Frye, B, et al. Nasal decolonization with alcohol based sanitizer is effective at preventing surgical site infection following total joint arthroplasty. Abstract. American Academy of Orthopaedic Surgeons conference, September 7–9, 2018. New Orleans, LA.Google Scholar
Tande, A, Patel, R. Prosthetic joint infection. Clin Micro Rev 2014;27:302–345.CrossRefGoogle ScholarPubMed
Levy, PY, Fenollar, F, Stein, A, et al. Postoperative shoulder arthritis: an emerging clinical entity. Clin Infect Dis 2008;46:1884–1886.CrossRefGoogle ScholarPubMed
Athwal, GS, Cofield, RH. Deep infections after rotator cuff repair. Shoulder Elbow Surg 2007;16:306–311.CrossRefGoogle ScholarPubMed
Sethi, PM, Sabetta, JR, Stuek, SJ, Miller, SR. Incidence of culture positive Propionibacterium acnes in shoulder arthroscopy. J Shoulder Elbow Surg 2015;24: 796–803.CrossRefGoogle Scholar
Matsen, FA, Butler-Wu, S, Carofino, BC, et al. Origin of Propionibacterium in surgical wounds and evidence based approach for culturing Propionibacterium acnes from surgical sites. J Bone Joint Surg Am 2013;95:1811–1817.CrossRefGoogle Scholar
Saltzman, MD, Marecek, GS, Edwards, SL, et al. Infections after shoulder surgery. J Am Acad Orthop Surg 2011;19:208–218.CrossRefGoogle ScholarPubMed
Sabetta, JR, Rana, VP, Vadasdi, KB, et al. Efficacy of topical benzoyl peroxide on the reduction of Propionibacterium acnes during shoulder surgery. J Shoulder Elbow Surg 2015;24: 995–1004. doi: 10.1016/jse.2015.04.CrossRefGoogle ScholarPubMed
Richards, BR, Emara, KM. Delayed infections after posterior TSRH spinal instrumentations for idiopathic scoliosis: revisited. Spine 2001;26:1990–1996.CrossRefGoogle Scholar
Sampedro, MF, Huddleston, PM, Piper, KE, et al. A biofilm approach to detect bacteria on removed spinal implants. Spine 2010;35:1218–1224.CrossRefGoogle ScholarPubMed
Shiono, Y, Ishii, K, Nagai, S, et al. Propionibacterium acnes cause delayed surgical infection only in the presence of an implant. Sci Rep 2016;6:32758. doi: 10.1038/srep32758.CrossRefGoogle Scholar
Walcott, B, Redjal, N, Coumann, J-VCE. Infection following operations on the central nervous system: deconstructing the myth of the sterile field. Neurosurg Focus 2012;33: 1–9. doi: 10.3171/2012.8/Focus12245.CrossRefGoogle ScholarPubMed
Ackermann, Y, Liu, J, Zbinden, R, et al. Propionibacterium avidum: a virulent pathogen causing hip periprosthetic joint infection. Clin Infect Dis 2018;66:54–63.CrossRefGoogle Scholar
Tammerlin, A, Hambraeus, A, Stahle, E. Source and route of methicillin-resistant Staphylococcus epidermiditis transmitted to the surgical wound during cardio-thoracic surgery. Possibility of preventing wound contamination by use of special scrub suits. J Hosp Infect 2001;47:266–276.CrossRefGoogle Scholar
Bitrover, CY, Marcusson, E, Ransjo, V. Spread of coagulase-negative Staphylococcus during cardiac operations in a modern operating room. Ann Thorac Surg 2000;69:1110–1115.CrossRefGoogle Scholar
Mansson, E, Hellmark, B, Sundquist, M, Soderquist, B. Sequence types of Staphylococcus epidermidis associated with prosthetic joint infections are not present in the laminar airflow during prosthetic joint surgery. APMIS 2015;123:589–595.CrossRefGoogle Scholar