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Surgery Today

, Volume 50, Issue 1, pp 56–67 | Cite as

Current status of post-operative infections due to antimicrobial-resistant bacteria after digestive tract surgery in Japan: Japan Postoperative Infectious Complications Survey in 2015 (JPICS’15)

  • Mao Hagihara
  • Shinya Kusachi
  • Yukiko Kato
  • Yuka Yamagishi
  • Toru Niitsuma
  • Hiroshige MikamoEmail author
  • Yoshio Takesue
  • Yoshinobu Sumiyama
Original Article

Abstract

Purpose

We herein report the findings of the Japan Postoperative Infectious Complication Survey in 2015 (JPICS'15), which evaluated the rate of post-operative infections and colonization due to antimicrobial-resistant (AMR) bacteria after digestive tract surgery.

Methods

This survey by the Japan Society of Surgical Infection included patients undergoing digestive tract surgery at 28 centers between September 2015 and March 2016. Data included patient background characteristics, type of surgery, contamination status, and type of post-operative infections, including surgical site infections (SSIs), remote infections (RIs), and colonization.

Results

During the study period, 7,565 surgeries (of 896 types) were performed; among them, 905 cases demonstrated bacteria after digestive tract surgery. The survey revealed that post-operative infections or colonization by AMR bacteria occurred in 0.9% of the patient cohort, constituting 7.5% of post-operative infections, including 5.6% of SSIs and 1.8% of RIs. Extended-spectrum β-lactamase-producing Enterobacteriaceae and methicillin-resistant Staphylococcus aureus were the predominant AMR bacteria isolated from patients after digestive tract surgery. Patients infected with AMR bacteria had a poor prognosis.

Conclusion

Our results reveal that 7.5% of the post-operative infections were due to AMR bacteria, indicating the need for antibacterial coverage against AMR bacteria in patients with critical post-operative infections.

Keywords

Surgical site infection Remote infection Post-operative infection Digestive tract surgery 

Notes

Acknowledgements

We would like to extend our deep appreciation to the participants of this survey. The participating institutions and chief participants were follows: Department of Gastroenterological Surgery, Fukuoka University (S. Takeno), Division of Surgery, Fujinomiya City General Hospital (T. Okumura), Department of Digestive Surgery, Nihon University School of Medicine (O. Aramaki), Department of Surgery, Nippon Medical School Tama-Nagayama Hospital (H. Maruyama), Institute of Gastroenterology, Nippon Medical School Musashikosugi Hospital (M. Watanabe), Department of Surgery, Nippon Medical School (H. Kanno), Department of Surgery, Toho University Omori medical center (T. Maeda), Department of Surgery, Toho University Sakura Medical Center (M. Nagashima), Department of Surgery, The Jikei University School of Medicine (M. Kanehira), Department of Surgery, Osaka Rosai Hospital (M. Murakami), Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine (S. Kubo), Gastroenterological Surgery, Chiba Cancer Center (Y. Nabeya), Department of Gastroenterological and General Surgery, School of Medicine, Showa University (A. Fujimori), Japanese Red Cross Ogawa Hospital (K. Shimura), Department of Surgery, Teine Keijinkai Hospital (M. Takada), Department of Surgery, Jiaikai Imamura hospital (S. Hokita), Sapporo General City Hospital (K. Yamamoto), Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health (T. Tamura), Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine (S. Takeda), Department of Innovative Surgery and Surgical Techniques Development, Mie University Graduate School of Medicine (M. Kobayashi), Departments of Surgery, Saiseikai Niigata Daini Hospital (A. Kuwabara), Department of Surgery, Keio University School of Medicine (K. Tokizawa), Department of Surgery, Kyoto-Katsura Hospital (R. Nishitai), Department of Digestive Surgery, Tsushimi Hospital (T. Yamamoto), Department of Infection Control and Prevention, Aichi Medical University Hospital (Y. Kato), Department of Surgery, Mazda Hospital (S. Akagi), Department of Gastroenterological Surgery, Kawasaki Saiwai Hospital (K. Narita).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect. 2008;70:3–10.CrossRefGoogle Scholar
  2. 2.
    Kusachi S, Sumiyama Y, Arima Y, Yoshida Y, Tanaka H, Nakamura Y, et al. Success of countermeasures against respiratory infection after digestive surgery by strict blood and fluid resuscitation. J Infect Chemother. 2007;13:172–6.CrossRefGoogle Scholar
  3. 3.
    Young PY, Khadaroo RG. Surgical site infections. Surg Clin North Am. 2014;94:1245–64.CrossRefGoogle Scholar
  4. 4.
    de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control. 2009;37:387–97.CrossRefGoogle Scholar
  5. 5.
    Featherall J, Miller JA, Bennett EE, Lubelski D, Wang H, Khalaf T, et al. Implementation of an infection prevention bundle to reduce surgical site infections and cost following spine surgery. JAMA Surg. 2016;151:988–90.CrossRefGoogle Scholar
  6. 6.
    Anaya DA, Cormier JN, Xing Y, Koller P, Gaido L, Hadfield D, et al. Development and validation of a novel stratification tool for identifying cancer patients at increased risk of surgical site infection. Ann Surg. 2012;255:134–9.CrossRefGoogle Scholar
  7. 7.
    Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999;20:725–30.CrossRefGoogle Scholar
  8. 8.
    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, Guideline for prevention of surgical site infection, Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;1999(20):250–78.Google Scholar
  9. 9.
    Emori TG, Gaynes RP. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev. 1993;6:428–42.CrossRefGoogle Scholar
  10. 10.
    Barber GR, Miransky J, Brown AE, Coit DG, Lewis FM, Thaler HT, et al. Direct observations of surgical wound infections at a comprehensive cancer center. Arch Surg. 1995;130:1042–7.CrossRefGoogle Scholar
  11. 11.
    Velasco E, Thuler LC, Martins CA, Dias LM, Conalves VM. Risk factors for infectious complications after abdominal surgery for malignant disease. Am J Infect Control. 1996;24:1–6.CrossRefGoogle Scholar
  12. 12.
    Pessaux P, Msika S, Atalla D, Hay JM, Flamant Y, French Association for Surgical Research. Risk factors for postoperative infectious complications in noncolorectal abdominal surgery: a multivariate analysis based on a prospective multicenter study of 4718 patients. Arch Surg. 2003;138:314–24.CrossRefGoogle Scholar
  13. 13.
    Morris CD, Sepkowitz K, Fonshell C, Margetson N, Eagan J, Miransky J, et al. Prospective identification of risk factors for wound infection after lower extremity oncologic surgery. Ann Surg Oncol. 2003;10:778–82.CrossRefGoogle Scholar
  14. 14.
    Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG, et al. Wound infection after elective colorectal resection. Ann Surg. 2004;239:599–605.CrossRefGoogle Scholar
  15. 15.
    Siegel JD, Rhinehart E, Jackson M, Chiarello L, Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control. 2007; 35:S165–93.Google Scholar
  16. 16.
    Hawser SP, Bouchillon SK, Hoban DJ, Badal RE, Hsueh PR, Paterson DL. Emergence of high levels of extended-spectrum-beta-lactamase-producing gram-negative bacilli in the Asia-Pacific region: data from the Study for Monitoring Antimicrobial Resistance Trends (SMART) program, 2007. Antimicrob Agents Chemother. 2009;53:3280–4.CrossRefGoogle Scholar
  17. 17.
    Hilty M, Betsch BY, Bogli-Stuber K, Heiniger N, Stadler M, Kuffer M, et al. Transmission dynamics of extended-spectrum beta-lactamase-producing Enterobacteriaceae in the tertiary care hospital and the household setting. Clin Infect Dis. 2012;55:967–75.CrossRefGoogle Scholar
  18. 18.
    Leistner R, Meyer E, Gastmeier P, Pfeifer Y, Eller C, Dem P, et al. Risk factors associated with the community-acquired colonization of extended-spectrum beta-lactamase (ESBL) positive Escherichia coli an exploratory case-control study. PLoS One. 2013;8:e74323.CrossRefGoogle Scholar
  19. 19.
    Thacker N, Pereira N, Banavali SD, Narula G, Vora T, Chinnaswamy G, et al. Alarming prevalence of community-acquired multidrug-resistant organisms colonization in children with cancer and implications for therapy: a prospective study. Indian J Cancer. 2014;51:442–6.CrossRefGoogle Scholar
  20. 20.
    Maraki S, Mavros MN, Kofteridis DP, Samonis G, Falagas ME. Epidemiology and antimicrobial sensitivities of 536 multi-drug resistant gram-negative bacilli isolated from patients treated in surgical wards. Surg Infect. 2012;13:326–31.CrossRefGoogle Scholar
  21. 21.
    Rolston KVI, Nesher L, Tarrand JT. Current microbiology of surgical site infections in patients with cancer: a retrospective review. Infect Dis Ther. 2014;3:245–56.CrossRefGoogle Scholar
  22. 22.
    Sammon J, Trinh VQ, Ravi P, Sukumar S, Gervais MK, Shariat SF, et al. Health care-associated infections after major cancer surgery: temporal trends, patterns of care, and effect on mortality. Cancer. 2013;119:2317–24.CrossRefGoogle Scholar
  23. 23.
    Fan Y, Wei Z, Wang W, Tan L, Jiang H, Tian L, et al. The incidence and distribution of surgical site infection in Mainland China: a meta-analysis of 84 prospective observational studies. Sci Rep. 2014;4:6783.CrossRefGoogle Scholar
  24. 24.
    Simkins J, Morris MI, Camargo JF, Vianna R, Beduschi T, Abbo LM. Clinical outcomes of intestinal transplant recipients colonized with multidrug-resistant organisms: a retrospective study. Transpl Int. 2017;30:924–31.CrossRefGoogle Scholar
  25. 25.
    Nakamura A, Miyake K, Misawa S, Kuno Y, Horii T, Kondo S, et al. Meropenem as predictive risk factor for isolation of multidrug-resistant Pseudomonas aeruginosa. J Hosp Infect. 2013;83:153–5.CrossRefGoogle Scholar
  26. 26.
    Gil CM, Climent MNM, Del Moral LJA, Durán PM, Rodríguez VD, Rodríguez CG. Evaluation of compliance with the antibiotic prophylaxis protocol in breast surgery and its effect on the incidence of surgical infection. An Sist Sanit Navar. 2019;0:70189.Google Scholar
  27. 27.
    Cataldo MA, Granata G, Petrosillo N. Antibacterial prophylaxis for surgical site infection in the elderly: practical application. Drugs Aging. 2017;34:489–98.CrossRefGoogle Scholar
  28. 28.
    Pawłowska I, Ziółkowski G, Wójkowska-Mach J, Bielecki T. Can surgical site infections be controlled through microbiological surveillance? A three-year laboratory-based surveillance at an orthopaedic unit, retrospective observatory study. Int Orthop. 2019. [Epub ahead of print]Google Scholar
  29. 29.
    Gaynes R, Richards C, Edwards J, Emori TG, Horan T, Alonso-Echanove J, et al. Feeding back surveillance data to prevent hospital-acquired infections. Emerg Infect Dis. 2001;7:295–8.CrossRefGoogle Scholar
  30. 30.
    Cruse PJ, Foord R. The epidemiology of wound infection. A 10-year prospective study of 62,939 wounds. Surg Clin North Am. 1980;60:27–40.CrossRefGoogle Scholar
  31. 31.
    Clinical and Laboratory Standards Institute. Performance standards for methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically; approved stand-tenth edition (M07–A10). Wayne, PA: Clinical and Laboratory Standards Institute; 2015.Google Scholar
  32. 32.
    Bhangu A, Fitzgerald JE, Harrison EM. Global academic surgery and global outcomes in surgery: developing a sustainable model for the development of audit and research capacity. JAMA Surg. 2016;151:94–5.CrossRefGoogle Scholar
  33. 33.
    Pinkney TD, Calvert M, Bartlett DC, Gheorghe A, Redman V, Dowswell G, et al. Impact of wound edge protection devices on surgical site infection after laparotomy: multicentre randomised controlled trial (ROSSINI Trial). BMJ. 2013;347:f4305.CrossRefGoogle Scholar
  34. 34.
    Smyth ET, McIlvenny G, Enstone JE, Emmerson AM, Humphreys H, Fitzpatrick F, et al. Four country healthcare associated infection prevalence survey 2006: overview of the results. J Hosp Infect. 2008;69:230–48.CrossRefGoogle Scholar
  35. 35.
    Allegranzi B, Nejad SB, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and metaanalysis. Lancet. 2011;377:228–41.CrossRefGoogle Scholar
  36. 36.
    Badia JM, Casey AL, Petrosillo N, Hudson P, Mitchell S, Crosby C. The impact of surgical site infection on healthcare costs and patient outcomes: a systematic review of the economic and quality of life burden associated with surgical site infections in six European countries. J Hosp Infect. 2017;96:1–15.CrossRefGoogle Scholar
  37. 37.
    Huttner B, Robicsek AA, Gervaz P, Perencevich EN, Schiffer E, Schrenzel J, et al. Epidemiology of methicillin-resistant Staphylococcus aureus carriage and MRSA surgical site infections in patients undergoing colorectal surgery: a cohort study in two centers. Surg Infect. 2012;13:401–5.CrossRefGoogle Scholar
  38. 38.
    Leistner R, Schroder C, Geffers C, Breier AC, Gastmeier P, Behnke M. Regional distribution of nosocomial infections due to ESBL-positive Enterobacteriaceae in Germany: data from the German National Reference Center for the Surveillance of Nosocomial Infections (KISS). Clin Microbiol Infect. 2015;21(255):e1–5.Google Scholar
  39. 39.
    Gaynes RP, Culver DH, Horan TC, Edwards JR, Richards C, Tolson JS. Surgical site infection (SSI) rates in the United States, 1992–1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis. 2001;33(Suppl 2):S69–77.CrossRefGoogle Scholar
  40. 40.
    Kaier K, Frank U, Hagist C, Conrad A, Meyer E. The impact of antimicrobial drug consumption and alcohol-based hand rub use on the emergence and spread of extended-spectrum b-lactamase-producing strains: a time-series analysis. J Antimicrob Chemother. 2009;63:609–14.CrossRefGoogle Scholar
  41. 41.
    Ministry of Health, Labour and Welfare. Japan nosocomial infections surveillance. 2016. https://www.nihjanis.jp/english/about/index.htmlofsubordinatedocument. Accessed 10 Dec 2017.
  42. 42.
    Saeed MJ, Dubberke ER, Fraser VJ, Olsen MA. Procedure-specific surgical site infection incidence varies widely within certain National Healthcare Safety Network surgery groups. Am J Infect Control. 2015;43:617–23.CrossRefGoogle Scholar
  43. 43.
    Surveillance of surgical site infections in Europe 2010–2011. Stockholm: European Centre for Disease Prevention and Control. 2013. https://ecdc.europa.eu/en/publications/Publications/SSI-in-europe-2010-2011.pdf of subordinate document. Accessed 10 Dec 2017.
  44. 44.
    Bratzler DW, Houck PM, Surgical Infection Prevention Guidelines Writers Workgroup, American Academy of Orthopaedic Surgeons, American Association of Critical Care Nurses, American Association of Nurse Anesthetists, et al. Antimicrobial prophylaxis for surgery: An advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis. 2004;38:1706–15.Google Scholar
  45. 45.
    Yun JS, Na KJ, Song SY, Kim S, Jeong IS, Oh SG. Comparison of perioperative outcomes following hybrid minimally invasive versus open Ivor Lewis esophagectomy for esophageal cancer. J Thorac Dis. 2017;9:3097–104.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Mao Hagihara
    • 1
  • Shinya Kusachi
    • 2
  • Yukiko Kato
    • 1
  • Yuka Yamagishi
    • 1
  • Toru Niitsuma
    • 2
  • Hiroshige Mikamo
    • 1
    Email author
  • Yoshio Takesue
    • 3
  • Yoshinobu Sumiyama
    • 4
  1. 1.Department of Clinical Infectious DiseasesAichi Medical University HospitalNagakuteJapan
  2. 2.Department of Surgery, Ohashi Medical CenterToho UniversityTokyoJapan
  3. 3.Department of Infection Prevention and ControlHyogo College of MedicineHyogoJapan
  4. 4.Toho UniversityTokyoJapan

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