Carriage of Extended-spectrum Beta-lactamase–producing Enterobacteriaceae and the Risk of Surgical Site Infection After Colorectal Surgery: A Prospective Cohort Study

• Published in: Clinical infectious diseases Vol. 68; no. 10; pp. 1699 - 1704
• Main Authors: Dubinsky-Pertzov, Biana, Temkin, Elizabeth, Harbarth, Stephan, Fankhauser-Rodriguez, Carolina, Carevic, Biljana, Radovanovic, Ivana, Ris, Frederic, Kariv, Yehuda, Buchs, Nicolas C, Schiffer, Eduardo, Cohen Percia, Shimrit, Nutman, Amir, Fallach, Noga, Klausner, Joseph, Carmeli, Yehuda
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 02.05.2019
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Antibiotic Prophylaxis; beta-Lactamases; Carrier State - microbiology; Carrier State - prevention & control; Cephalosporins - administration & dosage; Cephalosporins - adverse effects; Colorectal Surgery - adverse effects; Enterobacteriaceae - drug effects; Enterobacteriaceae - enzymology; Enterobacteriaceae Infections - etiology; Enterobacteriaceae Infections - prevention & control; Feces - microbiology; Female; Humans; Israel; Male; Middle Aged; Prospective Studies; Risk Factors; Serbia; Surgical Wound Infection - microbiology; Surgical Wound Infection - prevention & control; Switzerland; Serbia; Switzerland; Israel; colorectal surgery; surgical antibiotic prophylaxis; extended-spectrum beta-lactamase; surgical site infection
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciy768

Abstract Background Antibiotic prophylaxis that covers enteric pathogens is essential in preventing surgical site infections (SSIs) after colorectal surgery. Current prophylaxis regimens do not cover extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-PE). We aimed to determine whether the risk of SSI following colorectal surgery is higher in ESBL-PE carriers than in noncarriers. Methods We conducted a prospective cohort study of patients who underwent elective colorectal surgery in 3 hospitals in Israel, Switzerland, and Serbia between 2012 and 2017. We included patients who were aged ≥18 years, were screened for ESBL-PE carriage before surgery, received routine prophylaxis with a cephalosporin plus metronidazole, and did not have an infection at the time of surgery. The exposed group was composed of ESBL-PE–positive patients. The unexposed group was a random sample of ESBL-PE–negative patients. We collected data on patient and surgery characteristics and SSI outcomes. We fit logistic mixed effects models with study site as a random effect. Results A total of 3600 patients were screened for ESBL-PE; 13.8% were carriers SSIs occurred in 55/220 carriers (24.8%) and 49/440 noncarriers (11.1%, P < .001). In multivariable analysis, ESBL-PE carriage more than doubled the risk of SSI (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.50–3.71). Carriers had higher risk of deep SSI (OR, 2.25; 95% CI, 1.27–3.99). SSI caused by ESBL-PE occurred in 7.2% of carriers and 1.6% of noncarriers (OR, 4.23; 95% CI, 1.70–10.56). Conclusions ESBL-PE carriers who receive cephalosporin-based prophylaxis are at increased risk of SSI following colorectal surgery. Standard antibiotic prophylaxis administered before colorectal surgery does not cover extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-PE). We found that ESBL-PE carriers have more than twice the risk of noncarriers of developing surgical site infection following colorectal surgery.