FATORES DE RISCO E ESTRATÉGIAS DE PREVENÇÃO NA INFECÇÃO DE SÍTIO CIRÚRGICO
UMA REVISÃO NARRATIVA DA LITERATURA
DOI:
https://doi.org/10.65577/rs.v1i1.21Palavras-chave:
Fatores de risco, infecção de ferida cirúrgica, prevenção de doenças, antibiocoprofilaxia, tratamento de ferimentos com pressão negativaResumo
A infecção de sítio cirúrgico (ISC) é uma complicação relevante no pós-operatório, associada ao aumento da morbidade e dos custos
hospitalares. Seu desenvolvimento está relacionado a fatores como condições clínicas do paciente, características do procedimento e
adequação de medidas profiláticas. A investigação de fatores de risco e estratégias de prevenção é essencial para reduzir sua incidência. Trata-se de uma revisão narrativa baseada em artigos publicados nos últimos dez anos nas bases PubMed, Embase e Cochrane. Foram incluídos estudos clínicos, randomizados e observacionais que analisaram fatores de risco, intervenções e estratégias de prevenção. A ISC é mais prevalente em países de baixo IDH. Fatores de risco incluem obesidade, diabetes, imunossupressão, idade avançada, tabagismo e técnicas inadequadas. Os principais agentes etiológicos são bactérias gram-negativas como Escherichia coli e Pseudomonas aeruginosa. A profilaxia antibiótica, combinando vias oral e intravenosa, reduziu a taxa de ISC de 14,4% para 3,4%. Tecnologias como terapia com pressão negativa e protetores de borda de ferida, além de higiene rigorosa e abordagem multidisciplinar, demonstraram eficácia. A profilaxia antimicrobiana, preparação pré-operatória e adesão a protocolos estruturados são essenciais para prevenir ISCs, destacando-se a importância de novas tecnologias e estratégias integradas
Referências
1. Badia J, Casey A, Petrosillo N, Hudson P, Mitchell S, Crosby C. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect. 2017;96(1):1-15. doi:10.1016/j.jhin.2017.03.004.
2. Monahan M, Jowett S, Pinkney T, Brocklehurst P, Morton D, Abdali Z, Roberts T. Surgical site infection and costs in low- and middle-income countries: A systematic review of the economic burden. PLoS ONE. 2020;15(5):e0232960. doi:10.1371/journal.pone.0232960.
3. G M, H E, R M, L R, W R, L S, et al. Worldwide incidence of surgical site infections in general surgical patients: A systematic review and meta-analysis. Int J Surg. 2021;106:136. doi:10.1016/j.ijsu.2021.106136.
4. Owens C, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect. 2008;70 Suppl 2:3-10. doi:10.1016/S0195-6701(08)60017-1.
5. Fi T, Lim S. Surgical site infection after gastrointestinal surgery in children: an international, multicentre, prospective cohort study. BMJ Glob Health. 2020;5:e003429. doi:10.1136/bmjgh-2020-003429.
6. Liu Z, Dumville J, Norman G, Westby M, Blazeby J, McFarlane E, et al. Intraoperative interventions for preventing surgical site infection: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017;2:CD012653. doi:10.1002/14651858.CD012653.pub2.
7. Owens C, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect. 2008;70 Suppl 2:3-10. doi:10.1016/S0195-6701(08)60017-1.
8. Henriksen N, Meyhoff C, Wetterslev J, Wille-Jørgensen P, Rasmussen L, Jørgensen L. Clinical relevance of surgical site infection as defined by the criteria of the Centers for Disease Control and Prevention. J Hosp Infect. 2010;75(3):173-7. doi:10.1016/j.jhin.2009.12.022.
9. Hedrick T, Harrigan A, Sawyer R, Turrentine F, Stukenborg G, Umapathi B, et al. Defining Surgical Site Infection in Colorectal Surgery: An Objective Analysis Using Serial Photographic Documentation. Dis Colon Rectum. 2015;58(10):1070–1077. doi:10.1097/DCR.0000000000000466.
10. Bhangu A, Ademuyiwa AO, Aguilera ML, Alexander P, Al-Saqqa SW, Borda-Luque G, et al. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. Lancet Infect Dis. 2018;18(5):516–25. doi:10.1016/S1473-3099(18)30101-4.
11. 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(6):617–23. doi:10.1016/j.ajic.2015.02.021.
12. Silvestri M, Dobrinja C, Scomersi S, Giudici F, Turoldo A, Princic E, et al. Modifiable and non-modifiable risk factors for surgical site infection after colorectal surgery: a single-center experience. Surg Today. 2018;48(3):338-345. doi:10.1007/s00595-017-1590-y.
13. Meijs AP, Koek MBG, Vos MC, Geerlings SE, Vogely HC, de Greeff SC. The effect of body mass index on the risk of surgical site infection. Infect Control Hosp Epidemiol. 2019;40(9):991–6. doi:10.1017/ice.2019.175.
14. Al-Hajri A, Ghabisha S, Ahmed F, Al-Wageeh S, Badheeb M, Alyhari Q, et al. Identification of predictive factors for surgical site infections in gastrointestinal surgeries: A retrospective cross-sectional study in a resource-limited setting. F1000Res. 2024;12:733. doi:10.12688/f1000research.129042.1.
15. Akhter MSJ, Verma R, Madhukar KP, Vaishampayan AR, Unadkat PC. Incidence of surgical site infection in postoperative patients at a tertiary care centre in India. J Wound Care. 2016;25(4):210–7. doi:10.12968/jowc.2016.25.4.210.
16. Ely S, Rothenberg KA, Beattie G, Gologorsky RC, Huyser MR, Chang CK. Modern elective laparoscopic cholecystectomy carries extremely low postoperative infection risk. J Surg Res. 2020;246:506-511. doi:10.1016/j.jss.2019.09.038.
17. Tserenpuntsag B, Haley V, Antwerpen CV, Doughty D, Gase KA, Hazamy PA, et al. Surgical site infection risk factors identified for patients undergoing colon procedures, New York State 2009–2010. Infect Control Hosp Epidemiol. 2014;35(8):1006–12. doi:10.1086/677634.
18. Wilhelm NB, Bonsall TJ, Miller CL. The effect of beta-lactam allergy status on the rate of surgical site infections. Ann Surg. 2020;Publish Ahead of Print. doi:10.1097/SLA.0000000000003898.
19. Lam PW, Tarighi P, Elligsen M, Gunaratne K, Nathens AB, Tarshis J, Leis JA. Self-reported beta-lactam allergy and the risk of surgical site infection: a retrospective cohort study. Infect Control Hosp Epidemiol. 2020;41(4):438-443. doi:10.1017/ice.2019.374.
20. Messer N, Melland MS, Miller BT, Krpata DM, Lucas RA, Beffa J, Zheng X, et al. Evaluating the impact of lifting mandatory smoking cessation prior to elective abdominal wall reconstruction: A single-center experience. Am J Surg. 2024;229:52–6. doi:10.1016/j.amjsurg.2023.09.015.
21. Wang Z, Chen J, Wang P, Jie Z, Jin W, Wang G, et al. Surgical site infection after gastrointestinal surgery in China: a multicenter prospective study. Am J Surg. 2019;240:206–18. doi:10.1016/j.amjsurg.2019.02.023.
22. O’Brien WJ, Gupta K, Itani KMF. Association of postoperative infection with risk of long-term infection and mortality. JAMA Surg. 2020;155(1):61. doi:10.1001/jamasurg.2019.4686.
23. Alkaaki A, Al-Radi OO, Khoja A, Alnawawi A, Maghrabi A, et al. Surgical site infection following abdominal surgery: a prospective cohort study. Can J Surg. 2019;62(2):111–7. doi:10.1503/cjs.004818.
24. Apisarnthanarak A, Kondo S, Mingmalairak C, Mahawongkajit P, Juntong J, Limpavitayaporn P, et al. Outcomes of extended-spectrum beta-lactamases producing Enterobacteriaceae colonization among patients undergoing abdominal surgery. Infect Control Hosp Epidemiol. 2019;40(11):1290–3. doi:10.1017/ice.2019.280.
25. Kalakouti E, Simillis C, Pellino G, Mughal N, Warren O, Mills S, et al. Characteristics of surgical site infection following colorectal surgery in a tertiary center: Extended-spectrum β-lactamase-producing bacteria culprits in disease. Wounds. 2017;30(4):108–13.
26. Vallejo M, Cuesta D, Florez LE. Development of a surgical site infection at a tertiary hospital in Colombia: a clinical and microbiological profile. Open Forum Infect Dis. 2019;6(Supplement_2):S450. doi:10.1093/ofid/ofz360.1184.
27. Dornfeld M, Lovely JK, Huebner M, Larson DW. Surgical site infection in colorectal surgery: A study in antibiotic duration. Dis Colon Rectum. 2017;60(9):971–8. doi:10.1097/DCR.0000000000000886.
28. Arezzo A, Mistrangelo M, Bonino MA, Salusso P, Forcignanò E, Vettoretto N, et al. Oral neomycin and bacitracin are effective in preventing surgical site infections in elective colorectal surgery: A multicentre, randomized, parallel, single-blinded trial (COLORAL-1). Updates Surg. 2021;73(5):1775–86. doi:10.1007/s13304-021-00961-7.
29. Surat G, Meyer-Sautter P, Rüsch J, Braun-Feldweg J, Germer CT, Lock JF. Retrospective cohort analysis of the effect of antimicrobial stewardship on postoperative antibiotic therapy in complicated intra-abdominal infections: Short-course therapy does not compromise patients’ safety. Antibiotics. 2022;11(1):120. doi:10.3390/antibiotics11010120.
30. Ito Y, Nojiri S, Iwanaga N, Kawano S, Noro T, Machida M, et al. Incisional surgical site infections by subcutaneous soaking of wound with aqueous 0.05% chlorhexidine gluconate in gastroenterological surgery: A randomized controlled trial. Surgery. 2024;176(3):803–9. doi:10.1016/j.surg.2024.02.004.
31. Callado GY, de Almeida Leite RM, Eduardo S, Barchi LC, Seddiq W, Correa IP, et al. Bowel preparation for elective colectomy in Crohn’s disease: Results from a global cohort study using the NSQIP database. Colorectal Dis. 2024;26(4):709–15. doi:10.1111/codi.16812.
32. Barbadoro P, Marmorale C, Recanatini C, Mazzarini G, Pellegrini I, D’Errico MM, et al. May the drain be a way in for microbes in surgical infections? Am J Infect Control. 2016;44(3):283–8. doi:10.1016/j.ajic.2015.10.002.
33. Jamali DM, Rahman IU, Ijazulhaq HM, Manzoor J, Liaqat K, Naz F. Effect of supplemental oxygen on risk of surgical wound infection. J Pak Med Assoc. 2022;16(9):804–6.
34. Surat G, Vogel U, Wiegering A, Germer CT, Lock JF. Defining the scope of antimicrobial stewardship interventions on the prescription quality of antibiotics for surgical intra-abdominal infections. Antibiotics. 2021;10(1):73. doi:10.3390/antibiotics10010073.
35. Gomila A, Carratalà J, Badia JM, Camprubí D, Piriz M, Shaw E, et al. Preoperative oral antibiotic prophylaxis reduces Pseudomonas aeruginosa surgical site infections after elective colorectal surgery: A multicenter prospective cohort study. BMC Infect Dis. 2018;18(1):1–10. doi:10.1186/s12879-018-3381-y.
36. Vu JV, Collins SD, Seese E, Hendren S, Englesbe MJ, Campbell DA, et al. Evidence that a regional surgical collaborative can transform care: Surgical site infection prevention practices for colectomy in Michigan. J Am Coll Surg. 2018;226(1):91-99. doi:10.1016/j.jamcollsurg.2017.10.013.
37. Gupta R, Darby GC, Imagawa DK. Efficacy of negative pressure wound treatment in preventing surgical site infections after Whipple procedures. Am Surg. 2017;83(10):1166-1169. PMID:29391117.
38. Carrano FM, Maroli A, Carvello M, Foppa C, Sacchi M, Crippa J, et al. Negative-pressure wound therapy after stoma reversal in colorectal surgery: A randomized controlled trial. BJS Open. 2021;5(6). doi:10.1093/bjsopen/zrab081.
39. Li PY, Yang D, Liu D, Sun SJ, Zhang LY. Reducing surgical site infection with negative-pressure wound therapy after open abdominal surgery: A prospective randomized controlled study. Scand J Surg. 2017;106(3):189–95. doi:10.1177/1457496916664586.
40. Atkins BZ, Wooten MK, Kistler J, Hurley K, Hughes GC, Wolfe WG. Does negative pressure wound therapy have a role in preventing poststernotomy wound complications? Surg Innov. 2009;16(2):140–6. doi:10.1177/1553350609337001.
41. Kurz A, Kopyeva T, Suliman I, Podolyak A, You J, Lewis B, et al. Supplemental oxygen and surgical-site infections: an alternating intervention controlled trial. Br J Anaesth. 2018;120(1):117–26. doi:10.1016/j.bja.2017.10.003.
42. Jamali DM, Ur Rahman I, Ijazulhaq HM, Manzoor J, Liaqat K, Naz F. Effect of Supplemental Oxygen on Risk of Surgical Wound Infection. Pak J Med Health Sci. 2022;16(09):804. doi:10.53350/pjmhs22169804
43. Kobayashi H, Uetake H, Yasuno M, Sugihara K. Effectiveness of wound-edge protectors for preventing surgical site infections after open surgery for colorectal disease: A prospective cohort study with two parallel study groups. Dig Surg. 2018;36(1):83–8. doi:10.1159/000488527.
44. Harnoss JC, Assadian O, Kramer A, Probst P, Müller-Lantzsch C, Scheerer L, et al. Comparison of chlorhexidine-isopropanol with isopropanol skin antisepsis for prevention of surgical-site infection after abdominal surgery. Br J Surg. 2018;105(7):893–9. doi:10.1002/bjs.10793.
45. Koek MBG, Hopmans TEM, Soetens LC, Wille JC, Geerlings SE, Vos MC, et al. Adhering to a national surgical care bundle reduces the risk of surgical site infections. PLoS ONE. 2017;12(9):e0184200. doi:10.1371/journal.pone.0184200.
46. Zammari NF, Abubakar U, Che Alhadi S, Khan FU. Use of surgical antibiotic prophylaxis and the prevalence and risk factors associated with surgical site infection in a tertiary hospital in Malaysia. Drugs Ther Perspect. 2022;38(5):235–42. doi:10.1007/s40267-022-00891-w.
47. Gupta R, Darby GC, Imagawa DK. Efficacy of negative pressure wound treatment in preventing surgical site infections after Whipple procedures. Am Surg. 2017;83(10):1166-1169. PMID:29391117.
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