Jenny Choi is a General Surgery Registrar at the Auckland DHB.
Extended Spectrum Beta-Lactamases (ESBL) Colonisation and the Risk of Surgical Site Infection in Colorectal Surgery
Background: Surgical site infection (SSI) is a common cause of morbidity following colorectal surgery. ESBL colonisation may increase risk of SSI as most antibiotics prophylaxis regimens do not cover ESBL.1 The review aims to establish the SSI rates in patients undergoing colorectal surgery and to examine the effect of ESBL colonisation on it.
Method: A retrospective review of all patients undergoing colorectal surgery in Waitemata District Health Board between January 2017 and June 2018 was performed. Data analysis included baseline ESBL colonisation status pre-operatively, SSI incidence as per standard CDC definition2 and risk of SSI in ESBL colonised compared to non-colonised. SSI rate was determined by several methodologies including clinical records, radiology reports, microbiology and coding. The level of intervention per SSI was also recorded.
Results: 528 patients were analysed. ESBL screening was performed in 63% of patients. ESBL colonisation was present in 8% for patients undergoing colorectal surgery. Overall SSI occurred in 27%. Within ESBL carriers, SSI was 54% compared to 21.2% in non-carriers (RR=2.55, p-value <0.05). ESBL carriers were also more likely to acquire ESBL infections than non-carriers (21.2% vs 1.6%).
Conclusion: This review strongly suggests that ESBL colonisation increases the risk of SSI after colorectal surgery. Routine screening of ESBL and change of prophylactic antibiotics covering ESBL for may be required for patients undergoing colorectal surgery to improve SSI.
1. Dubinsky-Pertzov, B. Temkin, E. Harbarth, S. et al. Carriage of Extended-spectrum Beta-lactamase–producing Enterobacteriaceae and the Risk of Surgical Site Infection After Colorectal Surgery: A Prospective Cohort Study. Clinical Infectious Diseases, ciy768, https://doi.org/10.1093/cid/ciy768