Risk Factors for Surgical Site Infection and Association With Infliximab Administration During Surgery for Crohn’s Disease
- 1 October 2013
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Diseases of the Colon & Rectum
- Vol. 56 (10), 1156-1165
- https://doi.org/10.1097/dcr.0b013e31829f682c
Abstract
BACKGROUND: Preoperative infliximab treatment may influence postoperative infectious complications in patients with Crohn’s disease. OBJECTIVE: The aim of this study was to identify predictors of surgical site infection after surgery for Crohn’s disease and evaluate the effects of preoperative infliximab administration. DESIGN: We performed a prospective surveillance and review of surgical site infections. SETTINGS: This study was conducted in the Surgical Department of Hyogo College of Medicine. PATIENTS: A total of 405 consecutive patients with Crohn’s disease who underwent abdominal surgery between January 2008 and December 2011 were included. MAIN OUTCOME MEASURES: Infection was diagnosed by the infection control team. The possible risk factors were analyzed by using logistic regression analyses to determine their predictive significance. RESULTS: Within the patient population, 20% of patients received infliximab, and 60% had penetrating disease. The median duration from the last infliximab infusion to surgery was 43 days (range, 4–80). The overall incidence of surgical site infection was 27%. The incidence of incisional surgical site infection was 18%, and the organ/space surgical site infection rate was 8%. In the multivariate analysis, proctectomy was the highest risk factor for all surgical site infection (OR, 3.4–11.8; p < 0.01). The administration of preoperative infliximab was not a risk factor for surgical site infection. By contrast, there was a significantly reduced risk of incisional surgical site infection in patients with penetrating disease who received infliximab (OR, 0.1; p < 0.01). LIMITATIONS: This study was a cohort study and not a randomized trial. The data analyses were performed for surgical site infections but not for other infectious complications. CONCLUSIONS: Proctectomy was a high-risk factor for surgical site infection in patients with Crohn’s disease. The administration of preoperative infliximab was not a risk factor for surgical site infection.Keywords
This publication has 18 references indexed in Scilit:
- Early use of immunosuppressives or TNF antagonists for the treatment of Crohn's disease: time for a changeGut, 2011
- A systematic review and meta-analysis of the effects of infliximab on the rate of colectomy and post-operative complications in patients with inflammatory bowel diseaseVideosurgery and Other Miniinvasive Techniques, 2011
- CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care settingAmerican Journal of Infection Control, 2008
- Fistulating Anal Crohn's Disease: Results of Combined Surgical and Infliximab TreatmentDiseases of the Colon & Rectum, 2006
- Serious Infections and Mortality in Association With Therapies for Crohn’s Disease: TREAT RegistryClinical Gastroenterology and Hepatology, 2006
- Wound Infection After Elective Colorectal ResectionAnnals of Surgery, 2004
- Maintenance infliximab for Crohn's disease: the ACCENT I randomised trialThe Lancet, 2002
- CDC Definitions of Nosocomial Surgical Site Infections, 1992: A Modification of CDC Definitions of Surgical Wound InfectionsInfection Control & Hospital Epidemiology, 1992
- Surgical wound infection rates by wound class, operative procedure, and patient risk indexAmerican Journal Of Medicine, 1991
- CDC definitions for nosocomial infections, 1988American Journal of Infection Control, 1988