Epidemiology Study Of Surgical Site Infection After Colorectal Surgery

Objective: To explore risk factors for surgical site infection(SSI)in Colorectal surgery and systematically review the efficacy and safety of applying Gentamicin Collagen Sponge(GCS)to preventing surgical site infections of colorectal surgery,in order to provide preventive measures against SSI.Methods: 1.A retrospective survey of patients with colorectal surgery in a hospital during June 2013 to June 2016 was conducted.The contents of the survey included: general condition of patients,basic diseases,operation informations and surgical site infection.The results were recorded in Epidata3.1 software and the risk factors related to infection was analyzed by unconditional Logistic regression analysis using SPSS18.0;2.This study searched 11 databases such as CENTRAL,MEDLINE,EMBASE,WEB OF SCIENCE,PUBMED,SCOPUS,CINAHL,CNKI,WANFANG,VIP and CBM.The random clinical trials(RCTs)which compared preventive effect of colorectal surgical site infection between GCS group and placebo control group or blank control group were included.The primary outcomes were the incidence of SSIs and adverse reactions.The secondary outcomes were superficial incision infection rate,deep incision infection rate and the infection rate of organ space.Two researchers independently screened literatures,extracted data and evaluated quality according to the inclusion and exclusion criteria.After screening,all included data was analyzed by Rev Man5.3 software.Results: 1.Retrospective analysis(1)A total of 397 patients were collected,including 281 colon surgerys and 116 rectal surgerys,240 males and 157 females,with an average age of(57.67±14.24)years old.There were 67 cases of surgical site infection,showing an infection rate of 16.88%.The difference of SSI between colonic surgery and rectal surgery was not statistically significant.(2)Unconditional single factor Logistic regression analysis showed that there were 9 risk factors for surgical site infection in colorectal surgery such as smoking(OR=3.26,[95%CI]=1.90~5.59);anemia(OR=2.07,[95%CI]=1.20~3.57;hypoalbuminemia(OR=2.97,[95%CI]=1.73~5.09);bleeding into ICU(OR=4.55,[95%CI]=2.46~8.43);emergency operation(OR=2.99,[95%CI]=1.57~5.70);large amount of bleeding in surgery(OR=1.18,[95%CI]=0.89~1.55);Surgeons with seniority less than 5 years(OR=4.63,[95%CI]=2.58~8.32);nonstandard using of antibiotics(OR=2.87,[95%CI]=1.66~4.98)and high NNIS score(OR=2.81,[95%CI]=1.93~4.10).(3)Multivariate analysis showed that smoking(OR=3.78,[95%CI]=2.01~7.08);hypoalbuminemia(OR=2.51,[95%CI]=1.30~4.84);Surgeons with seniority less than 5 years(OR=2.86,[95%CI]=1.39~5.88);nonstandard using of antibiotics(OR=2.50,[95%CI]=1.31~4.78)and high NNIS score(OR=1.83,[95%CI]=1.11~3.00)were independent risk factors for colorectal surgical site infection.2.Meta analysis(1)Data filtering: Totally 5340 articles were obtained in initial retrieval.After screening,removing duplicate documents by computer and manually operation,1870 patients from 10 RCTs were included.(2)Outcomes: The infection rates of surgical site(RR=0.73,[95%CI]=0.49~1.07);superficial wound(RR=1.31,[95%CI]=0.96~1.79);deep wound(RR=1.43,[95%CI]=0.82~2.49);organ space infection(RR=1.06,[95%CI]=0.59-1.91)and incision complication(RR=1.28,[95%CI]=0.85~1.95)in the GCS group were all not significantly different compared to those in the control group.(3)Subgroup analysis: When Dose of gentamicin in GCS was no larger than 200 mg,GCS applying could decrease the SSI rate compared to control group(RR=0.62,[95% CI]=0.42-0.93).Conclusion: 1.Smoking,hypoalbuminemia,Surgeons with seniority less than 5 years,nonstandard using of antibiotics and high NNIS score were independent risk factors for colorectal surgical site infection.There are lots of risk factors for SSI after colorectal surgery.It is necessary to pay attention to it and formulate preventive measures against SSI,so as to reduce the occurrence of SSI effectively.2.No certain effect of GCS on preventing surgical site infections following colorectal surgery has been observed.Clinical application GCS for preventing surgical site infections should be done with caution.