Antimicrobial resistance in Enterobacteriaceae is increasing worldwide. According to recent studies, the efficacy of surgical prophylaxis is also decreasing, with a significant increase in surgical site infections (SSI) following certain high-risk procedures, including colorectal surgery. Further, there are no clear, uniform clinical practice guidelines for the prevention of SSI.
In this session, lead investigator Benedikt Huttner1 explained that patients colonized with MDR Gram-negative bacteria (i.e. extended-spectrum beta lactamase producing Enterobacteriaceae [ESBL-E]) have a higher risk of SSI. Using multivariable analysis with data from a prospective cohort study in 3 hospitals in Israel, Switzerland, and Serbia, he showed that there was an association between SSI and selected characteristics, including ESBLE-E carriage (adjusted odds ratio: 2.36 [95% confidence interval, 1.50-3.71]). ESBL-E carriers were more likely to have had previous colorectal surgery (34.7% vs 23.6%; p=0.03) and less likely to have had colorectal cancer (67.1% vs 80.9%; p
He concluded that based on this study and others, it seems reasonable to adopt prophylaxis in certain types of surgery where Gram-negatives predominate as the cause of SSI or for certain high-risk procedures, including colorectal surgery, urologic interventions, and solid organ transplants. Based on the evidence in cardiac surgery, in the absence of better data, it is probably justifiable to administer routine prophylaxis, even in patients colonized with MDR Gram-negative bacteria. He added that carbapenem overuse for prophylaxis should be avoided, as there are few studies on the topic.