The Impact of Surgical Wound Bacterial Colonization on the Incidence of Surgical Site Infection After Lower Limb Vascular Surgery: A Prospective Observational Study

• Published in: European journal of vascular and endovascular surgery Vol. 47; no. 4; pp. 411 - 417
• Main Authors: Turtiainen, J, Hakala, T, Hakkarainen, T, Karhukorpi, J
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-04-2014
• Subjects: Aged; Aged, 80 and over; Bacterial colonization; Female; Humans; Incidence; Lower Extremity - microbiology; Lower Extremity - surgery; Male; Middle Aged; Peripheral vascular surgery; Prospective Studies; Risk Factors; Surgery; Surgical site infection; Surgical Wound Infection - complications; Surgical Wound Infection - epidemiology; Surgical Wound Infection - microbiology; Vascular Surgical Procedures - adverse effects; Surgical site infection; Peripheral vascular surgery; Bacterial colonization
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2013.12.025

Objective To study the relationship between surgical wound bacterial colonization and the development of surgical site infection (SSI) after lower limb vascular surgery. SSI is a major problem after lower limb vascular surgery. Most SSIs in vascular surgery are caused by Staphylococcal species that are part of normal skin flora. A prospective observational investigator blind study to examine quantitative and qualitative analysis of surgical wound bacterial colonization and the correlation with the development of SSI has been conducted. Methods The study cohort comprised 94 consecutive patients with 100 surgical procedures. Swabs for microbiological analyses were taken from surgical wounds at four different time intervals: before surgery, just before the surgical area had been scrubbed, at the end of surgery, and on the first and second postoperative days. Postoperative complications were recorded. Results Three hundred and eighty-seven skin bacterial samples from 100 surgical wounds were analyzed. The most common bacteria isolated were coagulase-negative staphylococci (80%), Corynebacterium species (25%), and Propionibacterium species (15%). In 13 (62%) cases, the same bacterial isolates were found in the perioperative study samples as in the infected wounds. The incidence of SSI was 21%. Multivariate analysis revealed that high bacterial load on the second postoperative day and diabetes independently increased the risk of SSI. Elective redo surgery was protective against the development of SSI. Conclusions A high bacterial load in the postoperative surgical wound independently increases the risk of the development of SSI after lower limb vascular surgery.