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Date Published:
31/10/2022
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Views PDF: 380
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Research Article
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Ha, N. T. T. ., Minh, L. T. N. ., Dung, V. T. ., Hoa, N. M., Anh, N. H. ., Khanh, N. G., & Tuan, V. A. . (2022). An overview of surgical site infection and prophylactic antibiotics in vascular surgery. The Vietnam Journal of Cardiovascular and Thoracic Surgery, 39, 27-36. https://doi.org/10.47972/vjcts.v39i.800
An overview of surgical site infection and prophylactic antibiotics in vascular surgery
Main Article Content
Abstract
Background: Vascular surgery is a complex procedure with many complications such as surgical site infections, graft infections, pneumonia, myocardial infarction, hemorrhage, and thromboembolism or thrombosis, in which, the most common complications are surgical site infection, and graft infection. Currently, antibiotic prophylaxis is considered the most effective practice to suppress surgical site infection in surgical procedures including vascular surgery. The aim of this paper is to review the surgical site infection and prophylactic antibiotics in vascular surgery.[1]
Method: A search was made by using Medline, PubMed, Scopus and Web of Science databases, and databases of journals in Vietnam.
Result: 1227 records were identified, of which 112 were included in this review. This included 90 researches, and 22 guidelines.
Conclusion: In vascular surgery, antibiotic prophylaxis is recommended in most guidelines for abdominal aortic surgery, lower limb vascular surgery, vascular surgery with prosthetic grafts or stents. The common antibiotic regimens are 1st generation cephalosporins – C1G (cefazolin), 2nd generation cephalosporins – C2G (cefuroxim) administrated 60 minutes before incision, and discontinued within 24 hours of surgery.
Article Details
Keywords
antibiotic prophylaxis, surgical site infections, graft infections, risk factors, vascular surgery, abdominal aortic surgery, lower limb vascular surgery, vascular surgery with prosthetic grafts
References
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2. Anagnostopoulos A, Ledergerber B, Kuster SP, Scherrer AU, Naf B, Greiner MA, et al. Inadequate Perioperative Prophylaxis and Postsurgical Complications After Graft Implantation Are Important Risk Factors for Subsequent Vascular Graft Infections: Prospective Results From the Vascular Graft Infection Cohort Study. Clin Infect Dis. 2019;69(4):621-30.
3. Mahmoud NN, Turpin RS, Yang G, Saunders WB. Impact of surgical site infections on length of stay and costs in selected colorectal procedures. Surg Infect (Larchmt). 2009;10(6):539-44.
4. Ott E, Bange FC, Sohr D, Teebken O, Mattner F. Risk factors associated with surgical site infections following vascular surgery at a German university hospital. Epidemiol Infect. 2013;141(6):1207-13.
5. Gajdos C, Hawn MT, Kile D, Henderson WG, Robinson T, McCarter M, et al. The risk of major elective vascular surgical procedures in patients with end-stage renal disease. Ann Surg. 2013;257(4):766-73.
6. Donker JM, van der Laan L, Hendriks YJ, Kluytmans JA. Evaluation of Staphylococcus aureus nasal carriage screening before vascular surgery. PLoS One. 2012;7(6):e38127.
7. Hicks CW, Bronsert M, Hammermeister KE, Henderson WG, Gibula DR, Black JH, 3rd, et al. Operative variables are better predictors of postdischarge infections and unplanned readmissions in vascular surgery patients than patient characteristics. J Vasc Surg. 2017;65(4):1130-41 e9.
8. Aziz F, Lehman EB. Open Abdominal Aortic Aneurysm Repair Is Associated with Higher Mortality Among Nonobese Patients and Higher Risk of Deep Wound Infections Among Obese Patients. Ann Vasc Surg. 2020;67:354-69.
9. Trinidad B, Rybin D, Doros G, Eslami M, Tan TW. Factors Associated with Wound Complications after Open Femoral Artery Exposure for Elective Endovascular Abdominal Aortic Aneurysm Repair. Int J Angiol. 2019;28(2):124-9.
10. Mangieri CM, Kauvar DS. Increasing Body Mass Index Predicts Wound Complications after Elective Endovascular Abdominal Aortic Aneurysm Repair. The American Surgeon. 2017;83(3):81-3.
11. Wiseman JT, Fernandes-Taylor S, Barnes ML, Saunders RS, Saha S, Havlena J, et al. Predictors of surgical site infection after hospital discharge in patients undergoing major vascular surgery. J Vasc Surg. 2015;62(4):1023-31 e5.
12. Faizer R, Dombrovskiy VY, Vogel TR. Impact of hospital-acquired infection on long-term outcomes after endovascular and open abdominal aortic aneurysm repair. Ann Vasc Surg. 2014;28(4):823-30.
13. Hughes K, Jackson JD, Prendergast TI, Rose DA, Bolorunduro O, Obirieze A, et al. Diabetes mellitus is not associated with major morbidity following open abdominal aortic aneurysm repair. J Surg Res. 2013;184(2):751-4.
14. Giles KA, Wyers MC, Pomposelli FB, Hamdan AD, Ching YA, Schermerhorn ML. The impact of body mass index on perioperative outcomes of open and endovascular abdominal aortic aneurysm repair from the National Surgical Quality Improvement Program, 2005-2007. J Vasc Surg. 2010;52(6):1471-7.
15. Ricco JB, InterGard Silver Study G. InterGard silver bifurcated graft: features and results of a multicenter clinical study. J Vasc Surg. 2006;44(2):339-46.
16. Davis FM, Sutzko DC, Grey SF, Mansour MA, Jain KM, Nypaver TJ, et al. Predictors of surgical site infection after open lower extremity revascularization. J Vasc Surg. 2017;65(6):1769-78 e3.
17. Pounds LL, Montes-Walters M, Mayhall CG, Falk PS, Sanderson E, Hunter GC, et al. A Changing Pattern of Infection After Major Vascular Reconstructions. Vascular and Endovascular Surgery. 2005;39(6):T1-T7.
18. Turtiainen J, Saimanen EI, Partio TJ, Makinen KT, Reinikainen MT, Virkkunen JJ, et al. Supplemental postoperative oxygen in the prevention of surgical wound infection after lower limb vascular surgery: a randomized controlled trial. World J Surg. 2011;35(6):1387-95.
19. Lee ES, Santilli SM, Olson MM, Kuskowski MA, Lee JT. Wound infection after infrainguinal bypass operations: multivariate analysis of putative risk factors. Surg Infect (Larchmt). 2000;1(4):257-63.
20. Farinas MC, Campo A, Duran R, Sarralde JA, Nistal JF, Gutierrez-Diez JF, et al. Risk factors and outcomes for nosocomial infection after prosthetic vascular grafts. J Vasc Surg. 2017;66(5):1417-26.
21. O'Brien R, Pocock N, Torella F. Wound infection after reconstructive arterial surgery of the lower limbs: risk factors and consequences. Surgeon. 2011;9(5):245-8.
22. Turtiainen J, Saimanen E, Partio T, Karkkainen J, Kiviniemi V, Makinen K, et al. Surgical wound infections after vascular surgery: prospective multicenter observational study. Scand J Surg. 2010;99(3):167-72.
23. Antonios VS, Noel AA, Steckelberg JM, Wilson WR, Mandrekar JN, Harmsen WS, et al. Prosthetic vascular graft infection: a risk factor analysis using a case-control study. J Infect. 2006;53(1):49-55.
24. Derksen WJ, Verhoeven BA, van de Mortel RH, Moll FL, de Vries JP. Risk factors for surgical-site infection following common femoral artery endarterectomy. Vasc Endovascular Surg. 2009;43(1):69-75.
25. Turtiainen J, Hakala T, Hakkarainen T, Karhukorpi J. The impact of surgical wound bacterial colonization on the incidence of surgical site infection after lower limb vascular surgery: a prospective observational study. Eur J Vasc Endovasc Surg. 2014;47(4):411-7.
26. AlMushcab N, Connolly R, Naughton P, Moneley D, McHugh S, Fitzpatrick F. Risks for Surgical Site Infection after Infra-inguinal Bypass. Ir Med J. 2019;112(8):988.
27. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt). 2013;14(1):73-156.
28. Jongkind J, Unlu C, Vahl A, Voorwinde T, van Nieuwenhuizen R, Bosma J. Antibiotic Prophylaxis in Autologous Vein Graft Reconstructions of the Lower Extremity. Vasc Endovascular Surg. 2015;49(1-2):24-9.
29. Eslami MH, Saadeddin Z, Rybin DV, Doros G, Siracuse JJ, Farber A. Association of frailty index with perioperative mortality and in-hospital morbidity after elective lower extremity bypass. J Vasc Surg. 2019;69(3):863-74 e1.
30. Langenberg JCM, Roijers J, Kluytmans J, de Groot HGW, Ho GH, Veen EJ, et al. Do Surgical Site Infections in Open Aortoiliac Surgery Differ Between Occlusive and Aneurysmal Arterial Disease? Vasc Endovascular Surg. 2020;54(7):618-24.
31. Stewart AH, Eyers PS, Earnshaw JJ. Prevention of infection in peripheral arterial reconstruction: a systematic review and meta-analysis. J Vasc Surg. 2007;46(1):148-55.
32. Singh R, Mesh CL, Aryaie A, Dwivedi AK, Marsden B, Shukla R, et al. Benefit of a single dose of preoperative antibiotic on surgical site infection in varicose vein surgery. Ann Vasc Surg. 2012;26(5):612-9.
33. Walker M, Litherland HK, Murphy J, Smith JA. Comparison of prophylactic antibiotic regimens in patients undergoing vascular surgery. J Hosp Infect. 1984;5 Suppl A:101-6.
34. World Health Organization. Global guidelines for the prevention of surgical site infection, second edition. 2018.
35. Bộ Y tế. Hướng dẫn sử dụng kháng sinh (ban hành kèm theo Quyết định số 708/QĐ-BYT ngày 02/03/2015) của Bộ trưởng Bộ Y tế. 2015. p. 258-62.
36. Chakfe N, Diener H, Lejay A, Assadian O, Berard X, Caillon J, et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections. Eur J Vasc Endovasc Surg. 2020;59(3):339-84.
37. Chehab MA, Thakor AS, Tulin-Silver S, Connolly BL, Cahill AM, Ward TJ, et al. Adult and Pediatric Antibiotic Prophylaxis during Vascular and IR Procedures: A Society of Interventional Radiology Practice Parameter Update Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology. J Vasc Interv Radiol. 2018;29(11):1483-501 e2.
38. A Global Declaration on Appropriate Use of Antimicrobial Agents across the Surgical Pathway. Surg Infect (Larchmt). 2017;18(8):846-53.
39. Chaikof EL, Dalman RL, Eskandari MK, Jackson BM, Lee WA, Mansour MA, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67(1):2-77 e2.
40. Government of South Australia. Surgical Antimicrobial Prophylaxis Clinical Guideline. 2017.
41. Martin C, Auboyer C, Boisson M, Dupont H, Gauzit R, Kitzis M, et al. Antibioprophylaxis in surgery and interventional medicine (adult patients). Update 2017. Anaesth Crit Care Pain Med. 2019;38(5):549-62.
42. Scottish Intercollegiate Guidelines Network. Antibiotic prophylaxis in surgery: A national clinical guideline. 2014.
43. Rezk F, Astrand H, Acosta S. Antibiotic Prophylaxis With Trimethoprim/Sulfamethoxazole Instead of Cloxacillin/Cefotaxime Increases Inguinal Surgical Site Infection Rate After Lower Extremity Revascularization. Int J Low Extrem Wounds. 2019;18(2):135-42.
44. Patrick S, James C, Ali A, Lawson S, Mary E, Modak A. Vascular surgical antibiotic prophylaxis study (VSAPS). Vasc Endovascular Surg. 2010;44(7):521-8.
45. Lohsiriwat V M, PhD¹, Chinswangwatanakul V, MD, PhD¹, Lohsiriwat D, MD¹, Rongrungruang Y, MD², , Malathum K M, Ratanachai P, MD⁴, Butsripoom B, MS, PhD⁵, Asdornwised U, MS, PhD⁶, Boontham P, MD, PhD⁷. Guidelines for the Prevention of Surgical Site Infection: The Surgical Infection Society of Thailand Recommendations (Executive Summary). J Med Assoc Thai. 2019;103:99 - 105.
2. Anagnostopoulos A, Ledergerber B, Kuster SP, Scherrer AU, Naf B, Greiner MA, et al. Inadequate Perioperative Prophylaxis and Postsurgical Complications After Graft Implantation Are Important Risk Factors for Subsequent Vascular Graft Infections: Prospective Results From the Vascular Graft Infection Cohort Study. Clin Infect Dis. 2019;69(4):621-30.
3. Mahmoud NN, Turpin RS, Yang G, Saunders WB. Impact of surgical site infections on length of stay and costs in selected colorectal procedures. Surg Infect (Larchmt). 2009;10(6):539-44.
4. Ott E, Bange FC, Sohr D, Teebken O, Mattner F. Risk factors associated with surgical site infections following vascular surgery at a German university hospital. Epidemiol Infect. 2013;141(6):1207-13.
5. Gajdos C, Hawn MT, Kile D, Henderson WG, Robinson T, McCarter M, et al. The risk of major elective vascular surgical procedures in patients with end-stage renal disease. Ann Surg. 2013;257(4):766-73.
6. Donker JM, van der Laan L, Hendriks YJ, Kluytmans JA. Evaluation of Staphylococcus aureus nasal carriage screening before vascular surgery. PLoS One. 2012;7(6):e38127.
7. Hicks CW, Bronsert M, Hammermeister KE, Henderson WG, Gibula DR, Black JH, 3rd, et al. Operative variables are better predictors of postdischarge infections and unplanned readmissions in vascular surgery patients than patient characteristics. J Vasc Surg. 2017;65(4):1130-41 e9.
8. Aziz F, Lehman EB. Open Abdominal Aortic Aneurysm Repair Is Associated with Higher Mortality Among Nonobese Patients and Higher Risk of Deep Wound Infections Among Obese Patients. Ann Vasc Surg. 2020;67:354-69.
9. Trinidad B, Rybin D, Doros G, Eslami M, Tan TW. Factors Associated with Wound Complications after Open Femoral Artery Exposure for Elective Endovascular Abdominal Aortic Aneurysm Repair. Int J Angiol. 2019;28(2):124-9.
10. Mangieri CM, Kauvar DS. Increasing Body Mass Index Predicts Wound Complications after Elective Endovascular Abdominal Aortic Aneurysm Repair. The American Surgeon. 2017;83(3):81-3.
11. Wiseman JT, Fernandes-Taylor S, Barnes ML, Saunders RS, Saha S, Havlena J, et al. Predictors of surgical site infection after hospital discharge in patients undergoing major vascular surgery. J Vasc Surg. 2015;62(4):1023-31 e5.
12. Faizer R, Dombrovskiy VY, Vogel TR. Impact of hospital-acquired infection on long-term outcomes after endovascular and open abdominal aortic aneurysm repair. Ann Vasc Surg. 2014;28(4):823-30.
13. Hughes K, Jackson JD, Prendergast TI, Rose DA, Bolorunduro O, Obirieze A, et al. Diabetes mellitus is not associated with major morbidity following open abdominal aortic aneurysm repair. J Surg Res. 2013;184(2):751-4.
14. Giles KA, Wyers MC, Pomposelli FB, Hamdan AD, Ching YA, Schermerhorn ML. The impact of body mass index on perioperative outcomes of open and endovascular abdominal aortic aneurysm repair from the National Surgical Quality Improvement Program, 2005-2007. J Vasc Surg. 2010;52(6):1471-7.
15. Ricco JB, InterGard Silver Study G. InterGard silver bifurcated graft: features and results of a multicenter clinical study. J Vasc Surg. 2006;44(2):339-46.
16. Davis FM, Sutzko DC, Grey SF, Mansour MA, Jain KM, Nypaver TJ, et al. Predictors of surgical site infection after open lower extremity revascularization. J Vasc Surg. 2017;65(6):1769-78 e3.
17. Pounds LL, Montes-Walters M, Mayhall CG, Falk PS, Sanderson E, Hunter GC, et al. A Changing Pattern of Infection After Major Vascular Reconstructions. Vascular and Endovascular Surgery. 2005;39(6):T1-T7.
18. Turtiainen J, Saimanen EI, Partio TJ, Makinen KT, Reinikainen MT, Virkkunen JJ, et al. Supplemental postoperative oxygen in the prevention of surgical wound infection after lower limb vascular surgery: a randomized controlled trial. World J Surg. 2011;35(6):1387-95.
19. Lee ES, Santilli SM, Olson MM, Kuskowski MA, Lee JT. Wound infection after infrainguinal bypass operations: multivariate analysis of putative risk factors. Surg Infect (Larchmt). 2000;1(4):257-63.
20. Farinas MC, Campo A, Duran R, Sarralde JA, Nistal JF, Gutierrez-Diez JF, et al. Risk factors and outcomes for nosocomial infection after prosthetic vascular grafts. J Vasc Surg. 2017;66(5):1417-26.
21. O'Brien R, Pocock N, Torella F. Wound infection after reconstructive arterial surgery of the lower limbs: risk factors and consequences. Surgeon. 2011;9(5):245-8.
22. Turtiainen J, Saimanen E, Partio T, Karkkainen J, Kiviniemi V, Makinen K, et al. Surgical wound infections after vascular surgery: prospective multicenter observational study. Scand J Surg. 2010;99(3):167-72.
23. Antonios VS, Noel AA, Steckelberg JM, Wilson WR, Mandrekar JN, Harmsen WS, et al. Prosthetic vascular graft infection: a risk factor analysis using a case-control study. J Infect. 2006;53(1):49-55.
24. Derksen WJ, Verhoeven BA, van de Mortel RH, Moll FL, de Vries JP. Risk factors for surgical-site infection following common femoral artery endarterectomy. Vasc Endovascular Surg. 2009;43(1):69-75.
25. Turtiainen J, Hakala T, Hakkarainen T, Karhukorpi J. The impact of surgical wound bacterial colonization on the incidence of surgical site infection after lower limb vascular surgery: a prospective observational study. Eur J Vasc Endovasc Surg. 2014;47(4):411-7.
26. AlMushcab N, Connolly R, Naughton P, Moneley D, McHugh S, Fitzpatrick F. Risks for Surgical Site Infection after Infra-inguinal Bypass. Ir Med J. 2019;112(8):988.
27. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt). 2013;14(1):73-156.
28. Jongkind J, Unlu C, Vahl A, Voorwinde T, van Nieuwenhuizen R, Bosma J. Antibiotic Prophylaxis in Autologous Vein Graft Reconstructions of the Lower Extremity. Vasc Endovascular Surg. 2015;49(1-2):24-9.
29. Eslami MH, Saadeddin Z, Rybin DV, Doros G, Siracuse JJ, Farber A. Association of frailty index with perioperative mortality and in-hospital morbidity after elective lower extremity bypass. J Vasc Surg. 2019;69(3):863-74 e1.
30. Langenberg JCM, Roijers J, Kluytmans J, de Groot HGW, Ho GH, Veen EJ, et al. Do Surgical Site Infections in Open Aortoiliac Surgery Differ Between Occlusive and Aneurysmal Arterial Disease? Vasc Endovascular Surg. 2020;54(7):618-24.
31. Stewart AH, Eyers PS, Earnshaw JJ. Prevention of infection in peripheral arterial reconstruction: a systematic review and meta-analysis. J Vasc Surg. 2007;46(1):148-55.
32. Singh R, Mesh CL, Aryaie A, Dwivedi AK, Marsden B, Shukla R, et al. Benefit of a single dose of preoperative antibiotic on surgical site infection in varicose vein surgery. Ann Vasc Surg. 2012;26(5):612-9.
33. Walker M, Litherland HK, Murphy J, Smith JA. Comparison of prophylactic antibiotic regimens in patients undergoing vascular surgery. J Hosp Infect. 1984;5 Suppl A:101-6.
34. World Health Organization. Global guidelines for the prevention of surgical site infection, second edition. 2018.
35. Bộ Y tế. Hướng dẫn sử dụng kháng sinh (ban hành kèm theo Quyết định số 708/QĐ-BYT ngày 02/03/2015) của Bộ trưởng Bộ Y tế. 2015. p. 258-62.
36. Chakfe N, Diener H, Lejay A, Assadian O, Berard X, Caillon J, et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections. Eur J Vasc Endovasc Surg. 2020;59(3):339-84.
37. Chehab MA, Thakor AS, Tulin-Silver S, Connolly BL, Cahill AM, Ward TJ, et al. Adult and Pediatric Antibiotic Prophylaxis during Vascular and IR Procedures: A Society of Interventional Radiology Practice Parameter Update Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology. J Vasc Interv Radiol. 2018;29(11):1483-501 e2.
38. A Global Declaration on Appropriate Use of Antimicrobial Agents across the Surgical Pathway. Surg Infect (Larchmt). 2017;18(8):846-53.
39. Chaikof EL, Dalman RL, Eskandari MK, Jackson BM, Lee WA, Mansour MA, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67(1):2-77 e2.
40. Government of South Australia. Surgical Antimicrobial Prophylaxis Clinical Guideline. 2017.
41. Martin C, Auboyer C, Boisson M, Dupont H, Gauzit R, Kitzis M, et al. Antibioprophylaxis in surgery and interventional medicine (adult patients). Update 2017. Anaesth Crit Care Pain Med. 2019;38(5):549-62.
42. Scottish Intercollegiate Guidelines Network. Antibiotic prophylaxis in surgery: A national clinical guideline. 2014.
43. Rezk F, Astrand H, Acosta S. Antibiotic Prophylaxis With Trimethoprim/Sulfamethoxazole Instead of Cloxacillin/Cefotaxime Increases Inguinal Surgical Site Infection Rate After Lower Extremity Revascularization. Int J Low Extrem Wounds. 2019;18(2):135-42.
44. Patrick S, James C, Ali A, Lawson S, Mary E, Modak A. Vascular surgical antibiotic prophylaxis study (VSAPS). Vasc Endovascular Surg. 2010;44(7):521-8.
45. Lohsiriwat V M, PhD¹, Chinswangwatanakul V, MD, PhD¹, Lohsiriwat D, MD¹, Rongrungruang Y, MD², , Malathum K M, Ratanachai P, MD⁴, Butsripoom B, MS, PhD⁵, Asdornwised U, MS, PhD⁶, Boontham P, MD, PhD⁷. Guidelines for the Prevention of Surgical Site Infection: The Surgical Infection Society of Thailand Recommendations (Executive Summary). J Med Assoc Thai. 2019;103:99 - 105.