From the Guidelines
Surgical Site Infections (SSIs) should be classified and managed according to the CDC criteria, which categorize SSIs as superficial incisional, deep incisional, or organ space infections, with management strategies including drainage, irrigation, and antibiotic treatment as needed. The CDC guidelines provide recommendations for preventing infections at surgical sites, including appropriate antibiotic prophylaxis, proper skin preparation, maintenance of normothermia, and glycemic control for diabetic patients 1. According to the 2018 WSES/SIS-E consensus conference, SSIs are generally classified according to CDC criteria, and superficial incisional infections are the most common type of SSIs, while deep incisional and organ/space SSIs cause the most morbidity 1.
Key practices for preventing SSIs include:
- Appropriate antibiotic prophylaxis, typically cefazolin 2g IV for most procedures, given within 60 minutes before incision
- Proper skin preparation with chlorhexidine-alcohol solution
- Maintenance of normothermia during surgery
- Glycemic control for diabetic patients
- Proper hand hygiene by surgical staff
- Appropriate hair removal using clippers rather than razors
- Maintaining a sterile operating environment
- Postoperative wound care and surveillance for signs of infection
The primary therapy for SSI is to open the incision, evacuate the infected material, and continue dressing changes until the wound heals by secondary intention, with antibiotic treatment initiated in cases of systemic inflammatory response or signs of organ failure 1. It is essential to note that the risk factors associated with SSIs, such as patient factors (e.g., age, malnutrition, diabetes, smoking, obesity) and surgical factors (e.g., type of procedure, duration of surgery), should be taken into consideration when managing SSIs 1.
In terms of specific management strategies, incisional SSIs should always be drained, irrigated, and if needed, opened and debrided, with percutaneous drainage, wound irrigation, and negative pressure-assisted wound management being effective options 1. Additionally, superficial incisional SSIs that have been opened can usually be managed without antibiotics, while patients with incisional SSIs and systemic inflammatory response or signs of organ failure should receive empiric broad-spectrum antibiotic treatment 1.
From the Research
Surgical Site Infections (SSIs) and CDC Guidelines
- SSIs are among the most prevalent and costly healthcare-associated infections, resulting in poor patient outcomes and even death 2, 3, 4.
- The Centers for Disease Control and Prevention (CDC) has provided guidelines for the prevention of SSIs, including recommendations for antimicrobial prophylaxis, skin preparation, and glycemic control 5.
- The CDC guidelines recommend that patients shower or bathe with soap or an antiseptic agent on at least the night before the operative day, and that antimicrobial prophylaxis be administered only when indicated based on published clinical practice guidelines 5.
Prevention and Treatment of SSIs
- Evidence-based preventive measures, such as appropriate antimicrobial prophylaxis, can decrease the risk of SSI 3, 4.
- Aggressive surgical debridement and effective antimicrobial therapy are needed to optimize the treatment of SSI 4.
- New antibiotics, such as avibactam and dalbavancin, may be alternatives to existing treatment, but should be used only on the ground of susceptibility testing and if standard drugs are inappropriate 6.
Role of Cefazolin in SSI Prevention
- Cefazolin is a first-generation cephalosporin antibiotic that is widely used for surgical prophylaxis in a variety of surgical disciplines 2.
- A meta-analysis of clinical trials comparing cefazolin to cefuroxime, ceftriaxone, and cefamandole found that cefazolin is as effective as these agents in preventing SSIs 2.