Infections at the surgical site continue to occur in as many as 20% of elective colon resection cases. Methods to reduce these infections are inconsistently applied. Surgical site infection (SSI) is the result of multiple interactive variables including the inoculum of bacteria that contaminate the site, the virulence of the contaminating microbes, and the local environment at the surgical site. These variables that promote infection are potentially offset by the effectiveness of the host defense. Reduction in the inoculum of bacteria is achieved by appropriate surgical site preparation, systemic preventive antibiotics, and use of mechanical bowel preparation in conjunction with the oral antibiotic bowel preparation. Intraoperative reduction of hematoma, necrotic tissue, foreign bodies, and tissue dead space will reduce infections. Enhancement of the host may be achieved by perioperative supplemental oxygenation, maintenance of normothermia, and glycemic control. These methods require additional research to identify optimum application. Uniform application of currently understood methods and continued research into new methods to reduce microbial contamination and enhancement of host responsiveness can lead to better outcomes. 1. Introduction Elective colon surgery continues to have the highest rate of infection at the surgical site among all elective surgical procedures. These infections span a continuum of mild superficial infection to those that are deep-seated within the abdominal cavity and pose a serious threat to the patient’s survival. These infections are associated with considerable patient morbidity as a general rule and frequently require reoperation, prolonged hospitalization, and readmission to the hospital during the course of management. Surgical site infection (SSIs) have proven to be very costly in addition to the attendant patient morbidity [1, 2]. Because of the frequency and severity of these infections, there has been nearly a full century of efforts to define improved processes for prevention. Numerous methods have been proposed and employed before and during elective colon surgery to prevent infection at the surgical site. Many have strong scientific foundation, while others are driven solely by expert opinion. This presentation will attempt to provide a comprehensive context of the pathogenesis of SSI following elective colon surgery and to define those methods that have evidence to support use for prevention. In past decades it has been the practice to refer to wound infections as separate entities from infections that occur in
References
[1]
K. B. Kirkland, J. P. Briggs, S. L. Trivette, W. E. Wilkinson, and D. J. Sexton, “The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs,” Infection Control and Hospital Epidemiology, vol. 20, no. 11, pp. 725–730, 1999.
[2]
D. E. Fry, “The surgical infection prevention project: processes, outcomes, and future impact,” Surgical Infections, vol. 7, supplement 3, pp. S17–S26, 2006.
[3]
T. C. Horan, R. P. Gaynes, W. J. Martone, W. R. Jarvis, and T. G. Emori, “CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections,” Infection Control and Hospital Epidemiology, vol. 13, no. 10, pp. 606–608, 1992.
[4]
Centers for Disease Control, “July 2013 CDC/NHSN protocol clarifications,” http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf.
[5]
M. C. Robson, T. J. Krizek, and J. P. Heggers, “Biology of surgical infection,” Current Problems in Surgery, vol. 10, no. 3, pp. 1–62, 1973.
[6]
T. J. Krizek and M. C. Robson, “Evolution of quantitative bacteriology in wound management,” American Journal of Surgery, vol. 130, no. 5, pp. 579–584, 1975.
[7]
S. Ahmed, G. T. Macfarlane, A. Fite, A. J. McBain, P. Gilbert, and S. Macfarlane, “Mucosa-associated bacterial diversity in relation to human terminal ileum and colonic biopsy samples,” Applied and Environmental Microbiology, vol. 73, no. 22, pp. 7435–7442, 2007.
[8]
E. J. Poth, “Historical development of intestinal antisepsis,” World Journal of Surgery, vol. 6, no. 2, pp. 153–159, 1982.
[9]
A. B. Onderdonk, J. G. Bartlett, T. Louie, et al., “Microbial synergy in experimental intra abdominal abscess,” Infection and Immunity, vol. 13, no. 1, pp. 22–26, 1976.
[10]
H. C. Polk Jr. and A. A. Miles, “Enhancement of bacterial infection by ferric iron: kinetics, mechanisms, and surgical significance,” Surgery, vol. 70, no. 1, pp. 71–77, 1971.
[11]
S. D. Elek and P. E. Conen, “The virulence of Staphylococcus pyogenes for man, a study of the problems of wound infection,” British Journal of Experimental Pathology, vol. 38, no. 6, pp. 573–586, 1957.
[12]
T. I. A. Sorensen, G. G. Nielsen, P. K. Andersen, and T. W. Teasdale, “Genetic and environmental influences on premature death in adult adoptees,” The New England Journal of Medicine, vol. 318, no. 12, pp. 727–732, 1988.
[13]
B. D. Shogan, E. M. Carlisle, J. C. Alverdy, and K. Umanskiy, “Do we really know why colorectal anastomoses leak?” Journal of Gastrointestinal Surgery, vol. 17, pp. 1698–1707, 2013.
[14]
J. Bruce, Z. H. Krukowski, G. Al-Khairy, E. M. Russell, and K. G. M. Park, “Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery,” British Journal of Surgery, vol. 88, no. 9, pp. 1157–1168, 2001.
[15]
D. E. Fry and P. S. Barie, “The changing face of Staphylococcus aureus: a continuing surgical challenge,” Surgical Infections, vol. 12, no. 3, pp. 191–203, 2011.
[16]
E. S. Petherick, J. E. Dalton, P. J. Moore, and N. Cullum, “Methods for identifying surgical wound infection after discharge from hospital: a systematic review,” BMC Infectious Diseases, vol. 6, article 170, 2006.
[17]
D. E. Fry, M. Pine, B. L. Jones, and R. J. Meimban, “Control charts to identify adverse outcomes in elective colon resection,” American Journal of Surgery, vol. 203, no. 3, pp. 392–396, 2012.
[18]
J. R. Edwards, K. D. Peterson, Y. Mu et al., “National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009,” American Journal of Infection Control, vol. 37, no. 10, pp. 783–805, 2009.
[19]
J. W. Milsom, D. L. Smith, M. L. Corman, R. A. Howerton, A. E. Yellin, and D. R. Luke, “Double-blind comparison of single-dose alatrofloxacin and cefotetan as prophylaxis of infection following elective colorectal surgery,” American Journal of Surgery, vol. 176, supplement 6, pp. 46S–52S, 1998.
[20]
K. M. F. Itani, S. E. Wilson, S. S. Awad, E. H. Jensen, T. S. Finn, and M. A. Abramson, “Ertapenem versus cefotetan prophylaxis in elective colorectal surgery,” The New England Journal of Medicine, vol. 355, no. 25, pp. 2640–2651, 2006.
[21]
R. L. Smith, J. K. Bohl, S. T. McElearney et al., “Wound infection after elective colorectal resection,” Annals of Surgery, vol. 239, no. 5, pp. 599–607, 2004.
[22]
D. H. Culver, T. C. Horan, R. P. Gaynes et al., “Surgical wound infection rates by wound class, operative procedure, and patient risk index,” American Journal of Medicine, vol. 91, supplement 3, pp. 152S–157S, 1991.
[23]
Y. Mu, J. R. Edwards, T. C. Horan, S. I. Berrios-Torres, and S. K. Fridkin, “Improving risk-adjusted measures of surgical site infection for the National Healthcare Safety Network,” Infection Control and Hospital Epidemiology, vol. 32, no. 10, pp. 970–986, 2011.
[24]
National Healthcare Safety Network, “Your guide to the standardized infection ratio,” http://www.cdc.gov/nhsn/PDFs/Newsletters/NHSN_NL_OCT_2010SE_final.pdf.
[25]
L. McKibben, T. Horan, J. I. Tokars et al., “Guidance on public reporting of healthcare-associated infections: recommendations of the healthcare infection control practices advisory committee,” American Journal of Infection Control, vol. 33, no. 4, pp. 217–226, 2005.
[26]
D. E. Fry, “Fifty ways to cause surgical site infections,” Surgical Infections, vol. 12, no. 6, pp. 497–500, 2011.
[27]
J. Webster and S. Osborne, “Preoperative bathing or showering with skin antiseptics to prevent surgical site infection,” Cochrane Database of Systematic Reviews, vol. 19, no. 2, Article ID CD004985, 2006.
[28]
C. E. Edmiston Jr., C. J. Krepel, G. R. Seabrook, B. D. Lewis, K. R. Brown, and J. B. Towne, “Preoperative shower revisited: can high topical antiseptic levels be achieved on the skin surface before surgical admission?” Journal of the American College of Surgeons, vol. 207, pp. 233–239, 2008.
[29]
P. J. E. Cruse and R. Foord, “A five year prospective study of 23,649 surgical wounds,” Archives of Surgery, vol. 107, no. 2, pp. 206–210, 1973.
[30]
T. R. Vogel, V. Y. Dombrovskiy, and S. F. Lowry, “In-hospital delay of elective surgery for high volume procedures: the impact on infectious complications,” Journal of the American College of Surgeons, vol. 211, no. 6, pp. 784–790, 2010.
[31]
J. Tanner, D. Woodings, and K. Moncaster, “Preoperative hair removal to reduce surgical site infection,” Cochrane Database of Systematic Reviews, vol. 9, no. 11, Article ID CD004122, 2006.
[32]
J. W. Alexander, J. E. Fischer, and M. Boyajian, “The influence of hair-removal methods on wound infections,” Archives of Surgery, vol. 118, no. 3, pp. 347–352, 1983.
[33]
A. J. Mangram, T. C. Horan, M. L. Pearson, L. C. Silver, and W. R. Jarvis, “The hospital infection control practices advisory committee. Guidelines for prevention of surgical site infection, 1999,” Infection Control and Hospital Epidemiology, vol. 20, pp. 247–280, 1999.
[34]
S. R. Hart, A. Yajnik, J. Ashford, R. Springer, and S. Harvey, “Operating room fire safety,” Ochsner Journal, vol. 11, no. 1, pp. 37–42, 2011.
[35]
R. Aly and H. I. Maibach, “Comparative antibacterial efficacy of a 2-minute surgical scrub with chlorhexidine gluconate, povidone-iodine, and chloroxylenol sponge-brushes,” American Journal of Infection Control, vol. 16, no. 4, pp. 173–177, 1988.
[36]
N. P. O'Grady, M. Alexander, L. A. Burns et al., “Guidelines for the prevention of intravascular catheter-related infections,” American Journal of Infection Control, vol. 39, supplement 4, pp. S1–S34, 2011.
[37]
J. C. Dumville, E. McFarlane, P. Edwards, et al., “Preoperative skin antiseptics for preventing surgical wound infections after clean surgery,” Cochrane Database of Systematic Reviews, vol. 28, no. 3, Article ID CD003949, 2013.
[38]
I. Lee, R. K. Agarwal, B. Y. Lee, N. O. Fishman, and C. A. Umscheid, “Systematic review and cost analysis comparing use of chlorhexidine with use of iodine for preoperative skin antisepsis to prevent surgical site infection,” Infection Control and Hospital Epidemiology, vol. 31, no. 12, pp. 1219–1229, 2010.
[39]
R. O. Darouiche, M. J. Wall Jr., K. M. F. Itani et al., “Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis,” The New England Journal of Medicine, vol. 362, no. 1, pp. 18–26, 2010.
[40]
P. J. E. Cruse and R. Foord, “The epidemiology of wound infection. A 10-year prospective study of 62,939 wounds,” Surgical Clinics of North America, vol. 60, no. 1, pp. 27–40, 1980.
[41]
J. Webster and A. A. Alghamdi, “Use of plastic adhesive drapes during surgery for preventing surgical site infection,” Cochrane Database of Systematic Reviews, vol. 17, no. 4, Article ID CD006353, p. CD006353, 2007.
[42]
S. Towfigh, W. G. Cheadle, S. F. Lowry, M. A. Malangoni, and S. E. Wilson, “Significant reduction in incidence of wound contamination by skin flora through use of microbial sealant,” Archives of Surgery, vol. 143, no. 9, pp. 885–891, 2008.
[43]
J. P. Edwards, A. L. Ho, M. C. Tee, et al., “Wound protectors reduce surgical site infection: a meta-analysis of randomized controlled trials,” Annals of Surgery, vol. 256, pp. 53–59, 2012.
[44]
A. A. Miles, E. M. Miles, and J. Burke, “The value and duration of defence reactions of the skin to the primary lodgement of bacteria,” British Journal of Experimental Pathology, vol. 38, no. 1, pp. 79–96, 1957.
[45]
J. F. Burke, “The effective period of preventive antibiotic action in experimental incisions and dermal lesions,” Surgery, vol. 50, no. 1, pp. 161–168, 1961.
[46]
H. C. Polk Jr. and J. F. Lopez-Mayor, “Postoperative wound infection: a prospective study of determinant factors and prevention,” Surgery, vol. 66, no. 1, pp. 97–103, 1969.
[47]
H. H. Stone, C. A. Hooper, and L. D. Kolb, “Antibiotic prophylaxis in gastric, biliary and colonic surgery,” Annals of Surgery, vol. 184, no. 4, pp. 443–452, 1976.
[48]
H. H. Stone, B. B. Haney, and L. D. Kolb, “Prophylactic and preventive antibiotic therapy. Timing, duration and economics,” Annals of Surgery, vol. 189, no. 6, pp. 691–699, 1979.
[49]
M. L. Baum, D. S. Anish, and T. C. Chalmers, “A survey of clinical trials of antibiotic prophylaxis in colon surgery: evidence against further use of no-treatment controls,” The New England Journal of Medicine, vol. 305, no. 14, pp. 795–799, 1981.
[50]
M. McDonald, E. Grabsch, C. Marshall, and A. Forbes, “Single-versus multiple-dose antimicrobial prophylaxis for major surgery: a systematic review,” Australian and New Zealand Journal of Surgery, vol. 68, no. 6, pp. 388–396, 1998.
[51]
F. Song and A.-M. Glenny, “Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomized controlled trials,” British Journal of Surgery, vol. 85, no. 9, pp. 1232–1241, 1998.
[52]
D. E. Fry and D. E. Pitcher, “Antibiotic pharmacokinetics in surgery,” Archives of Surgery, vol. 125, no. 11, pp. 1490–1492, 1990.
[53]
B. Janson and K. Thursky, “Dosing of antibiotics in obesity,” Current Opinion in Infectious Diseases, vol. 25, pp. 634–649, 2012.
[54]
D. E. Fry, “The continued challenge of Staphylococcus aureus in the surgical patient,” The American Surgeon, vol. 79, pp. 1–10, 2013.
[55]
A. E. Simor, “Staphylococcal decolonisation: an effective strategy for prevention of infection?” The Lancet Infectious Diseases, vol. 11, no. 12, pp. 952–962, 2011.
[56]
R. Finkelstein, G. Rabino, T. Mashiah et al., “Vancomycin versus cefazolin prophylaxis for cardiac surgery in the setting of a high prevalence of methicillin-resistant staphylococcal infections,” Journal of Thoracic and Cardiovascular Surgery, vol. 123, no. 2, pp. 326–332, 2002.
[57]
J. H. Garlock and G. P. Seley, “The use of sulfanilamide in surgery of the colon and rectum. Preliminary report,” Surgery, vol. 5, no. 5, pp. 787–790, 1939.
[58]
W. M. Firor and A. F. Jonas, “The use of sulfanilylguanidine in surgical patients,” Annals of Surgery, vol. 114, no. 1, pp. 19–31, 1941.
[59]
W. M. Firor and E. J. Poth, “Intestinal antisepsis with special reference to sulfanilylguanidine,” Annals of Surgery, vol. 114, pp. 663–671, 1941.
[60]
E. J. Poth and C. A. Ross, “The clinical use of phthalylsulfathiazole,” The Journal of Laboratory and Clinical Medicine, vol. 29, no. 8, pp. 785–808, 1944.
[61]
E. J. Poth, “Sulfasuxidine and sulfathalidine,” Texas Reports on Biology & Medicine, vol. 4, pp. 68–102, 1946.
[62]
E. H. Spaulding, D. S. Madajewski, R. J. Rowe, and H. E. Bacon, “The effect of orally administered streptomycin and sulfathalidine upon the bacterial flora of the colon,” Journal of Bacteriology, vol. 58, pp. 279–289, 1949.
[63]
E. J. Poth, S. M. Fromm, R. I. Wise, and C. M. Hsiang, “Neomycin, a new intestinal antiseptic,” Texas Reports on Biology and Medicine, vol. 8, no. 3, pp. 353–360, 1950.
[64]
I. Cohn Jr., “Kanamycin for bowel sterilization,” Annals of the New York Academy of Sciences, vol. 76, no. 2, pp. 212–223, 1958.
[65]
J. G. Bartlett, V. L. Sutter, and S. M. Finegold, “Treatment of anaerobic infections with lincomycin and clindamycin,” The New England Journal of Medicine, vol. 287, no. 20, pp. 1006–1010, 1972.
[66]
S. L. Gorbach and J. G. Bartlett, “Anaerobic infections. 1,” The New England Journal of Medicine, vol. 290, no. 21, pp. 1177–1184, 1974.
[67]
R. L. Nichols, P. Broido, and R. E. Condon, “Effect of preoperative neomycin erythromycin intestinal preparation on the incidence of infectious complications following colon surgery,” Annals of Surgery, vol. 178, no. 4, pp. 453–462, 1973.
[68]
R. L. Nichols, R. E. Condon, and A. R. DiSanto, “Preoperative bowel preparation. Erythromycin base serum and fecal levels following oral administration,” Archives of Surgery, vol. 112, no. 12, pp. 1493–1496, 1977.
[69]
J. A. Washington II, W. H. Dearing, E. S. Judd, and L. R. Elveback, “Effect of preoperative antibiotic regimen on development of infection after intestinal surgery: prospective, randomized, double blind study,” Annals of Surgery, vol. 180, no. 4, pp. 567–572, 1974.
[70]
I. Cohn Jr. and J. D. Rives, “Antibiotic protection of colon anastomoses,” Annals of Surgery, vol. 141, pp. 707–717, 1955.
[71]
I. Cohn Jr. and A. B. Longacre, “Tetracycline (achromycin)-neomycin for preoperative colon preparation,” AMA Archives of Surgery, vol. 72, no. 3, pp. 371–376, 1956.
[72]
J. S. Clarke, R. E. Condon, and J. G. Bartlett, “Preoperative oral antibiotics reduce septic complications of colon operations: results of prospective, randomized, double-blind clinical study,” Annals of Surgery, vol. 186, no. 3, pp. 251–259, 1977.
[73]
D. M. Matheson, Y. Arabi, D. Baxter-Smith, et al., “Randomized multicentre trial of oral bowel preparation and antimicrobials for elective colorectal operations,” British Journal of Surgery, vol. 65, no. 9, pp. 597–600, 1978.
[74]
S. Wapnick, R. Guinto, I. Reizis, and H. H. LeVeen, “Reduction of postoperative infection in elective colon surgery with preoperative administration of kanamycin and erythromycin,” Surgery, vol. 85, no. 3, pp. 317–321, 1979.
[75]
G. F. Coppa, K. Eng, and T. H. Gouge, “Parenteral and oral antibiotics in elective colon and rectal surgery. A prospective, randomized trial,” American Journal of Surgery, vol. 145, no. 1, pp. 62–65, 1983.
[76]
D. J. Schoetz Jr., P. L. Roberts, J. J. Murray, J. A. Coller, and M. C. Veidenheimer, “Addition of parenteral cefoxitin to regimen of oral antibiotics for elective colorectal operations. A randomized prospective study,” Annals of Surgery, vol. 212, no. 2, pp. 209–212, 1990.
[77]
A. B. Kaiser, J. L. Herrington Jr., and J. K. Jacobs, “Cefoxitin versus erythromycin, neomycin, and cefazolin in colorectal operations,” Annals of Surgery, vol. 198, no. 4, pp. 525–530, 1983.
[78]
W. Y. Lau, K. W. Chu, G. P. Poon, and K. K. Ho, “Prophylactic antibiotics in elective colorectal surgery,” British Journal of Surgery, vol. 75, no. 8, pp. 782–785, 1988.
[79]
G. F. Coppa and K. Eng, “Factors involved in antibiotic selection in elective colon and rectal surgery,” Surgery, vol. 104, no. 5, pp. 853–858, 1988.
[80]
J. R. Reynolds, J. A. Jones, D. F. Evans, and J. D. Hardcastle, “Do preoperative oral antibiotics influence sepsis rates following elective colorectal surgery in patients receiving perioperative intravenous prophylaxis?” Surgical Research Communications, vol. 7, no. 1, pp. 71–77, 1989.
[81]
I. T. Khubchandani, M. C. Karamchandani, J. A. Sheets, J. J. Stasik, L. Rosen, and R. D. Riether, “Metronidazole vs. erythromycin, neomycin, and cefazolin in prophylaxis for colonic surgery,” Diseases of the Colon and Rectum, vol. 32, no. 1, pp. 17–20, 1989.
[82]
E. W. Taylor and G. Lindsay, “Selective decontamination of the colon before elective colorectal surgery. West of scotland surgical infection study group,” World Journal of Surgery, vol. 18, pp. 926–932, 1994.
[83]
C. S. McArdle, C. G. Morran, L. Pettit, C. G. Gemmell, J. D. Sleigh, and G. S. Tillotson, “Value of oral antibiotic prophylaxis in colorectal surgery,” British Journal of Surgery, vol. 82, no. 8, pp. 1046–1048, 1995.
[84]
J. A. Solla and D. A. Rothenberger, “Preoperative bowel preparation. A survey of colon and rectal surgeons,” Diseases of the Colon and Rectum, vol. 33, no. 2, pp. 154–159, 1990.
[85]
R. L. Nichols, J. W. Smith, R. Y. Garcia, R. S. Waterman, and J. W. C. Holmes, “Current practices of preoperative bowel preparation among North American colorectal surgeons,” Clinical Infectious Diseases, vol. 24, no. 4, pp. 609–619, 1997.
[86]
R. E. Condon and K. A. Ludwig, “Prevention of infection: intestinal antibiotics,” in Surgical Infections, D. E. Fry, Ed., pp. 135–141, Little, Brown and Co., Boston, Mass, USA, 1995.
[87]
Q. D. Zhu, Q. Y. Zhang, Q. Q. Zeng, Z. P. Yu, C. L. Tao, and W. J. Yang, “Efficacy of mechanical bowel preparation with polyethylene glycol in prevention of postoperative complications in elective colorectal surgery: a meta-analysis,” International Journal of Colorectal Disease, vol. 25, no. 2, pp. 267–275, 2010.
[88]
R. P. J. Miettinen, S. T. Laitinen, J. T. M？kel？, and M. E. P？？kk？nen, “Bowel preparation with oral polyethylene glycol electrolyte solution vs. no preparation in elective open colon resection,” Diseases of the Colon & Rectum, vol. 43, pp. 669–675, 2000.
[89]
E. Ram, Y. Sherman, R. Weil, T. Vishne, D. Kravarusic, and Z. Dreznik, “Is mechanical bowel preparation mandatory for elective colon surgery?” Archives of Surgery, vol. 140, no. 3, pp. 285–288, 2005.
[90]
P. Fa-Si-Oen, R. Roumen, J. Buitenweg et al., “Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery,” Diseases of the Colon and Rectum, vol. 48, no. 8, pp. 1509–1516, 2005.
[91]
P. Bucher, P. Gervaz, C. Soravia, B. Mermillod, M. Erne, and P. Morel, “Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery,” British Journal of Surgery, vol. 92, no. 4, pp. 409–414, 2005.
[92]
O. Zmora, A. Mahajna, B. Bar-Zakai et al., “Is mechanical bowel preparation mandatory for left-sided colonic anastomosis? Results of a prospective randomized trial,” Techniques in Coloproctology, vol. 10, no. 2, pp. 131–135, 2006.
[93]
C. M. E. Contant, W. C. J. Hop, H. P. van’t Sant, et al., “Mechanical bowel preparation for elective colorectal surgery: a multicenter randomized trial,” The Lancet, vol. 370, pp. 2112–2117, 2007.
[94]
B. Jung, L. P？hlman, P.-O. Nystr？m, et al., “Multicentre randomized clinical trial of mechanical bowel preparation in elective colon resection,” British Journal of Surgery, vol. 94, pp. 689–695, 2007.
[95]
M. J. Pena-Soria, J. M. Mayol, R. Anula, A. Arbeo-Escolar, and J. A. Fernandez-Represa, “Single-blinded randomized trial of mechanical bowel preparation for colon surgery with primary intraperitoneal anastomosis,” Journal of Gastrointestinal Surgery, vol. 12, no. 12, pp. 2103–2109, 2008.
[96]
H. P. Van't Sant, W. F. Weidema, W. C. J. Hop, H. J. M. Oostvogel, and C. M. E. Contant, “The influence of mechanical bowel preparation in elective lower colorectal surgery,” Annals of Surgery, vol. 251, no. 1, pp. 59–63, 2010.
[97]
F. Cao, J. Li, and F. Li, “Mechanical bowel preparation for elective colorectal surgery: updated systematic review and meta-analysis,” International Journal of Colorectal Disease, vol. 27, no. 6, pp. 803–810, 2012.
[98]
K. W. Markell, B. M. Hunt, P. D. Charron et al., “Prophylaxis and management of wound infections after elective colorectal surgery: a survey of the American society of Colon and rectal surgeons membership,” Journal of Gastrointestinal Surgery, vol. 14, no. 7, pp. 1090–1098, 2010.
[99]
C. Eskicioglu, S. S. Forbes, D. S. Fenech, and R. S. McLeod, “Preoperative bowel preparation for patients undergoing elective colorectal surgery: a clinical practice guideline endorsed by the Canadian Society of Colon and Rectal Surgeons,” Canadian Journal of Surgery, vol. 53, no. 6, pp. 385–395, 2010.
[100]
U. O. Gustafsson, M. J. Scott, W. Schwenk, et al., “Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS) society recommendations,” World Journal of Surgery, vol. 37, pp. 259–284, 2013.
[101]
R. T. Lewis, “Oral versus systemic antibiotic prophylaxis in elective colon surgery: a randomized study and meta-analysis send a message from the 1990s,” Canadian Journal of Surgery, vol. 45, no. 3, pp. 173–180, 2002.
[102]
R. L. Nelson, A. M. Glenny, and F. Song, “Antimicrobial prophylaxis for colorectal surgery,” Cochrane Database of Systematic Reviews, vol. 21, no. 1, Article ID CD001181, 2009.
[103]
D. E. Fry, “Colon preparation and surgical site infection,” American Journal of Surgery, vol. 202, no. 2, pp. 225–232, 2011.
[104]
C. F. Bellows, K. T. Mills, T. N. Kelly, and G. Gagliardi, “Combination of oral non-absorbable and intravenous antibiotics versus intravenous antibiotics alone in the prevention of surgical site infections after colorectal surgery: a meta-analysis of randomized controlled trials,” Techniques in Coloproctology, vol. 15, no. 4, pp. 385–395, 2011.
[105]
M. J. Englesbe, L. Brooks, J. Kubus et al., “A statewide assessment of surgical site infection following colectomy: the role of oral antibiotics,” Annals of Surgery, vol. 252, no. 3, pp. 514–519, 2010.
[106]
J. A. Cannon, L. K. Altom, R. J. Deierhoi, et al., “Preoperative oral antibiotics reduce surgical site infection following elective colorectal resections,” Diseases of the Colon & Rectum, vol. 55, pp. 1160–1166, 2012.
[107]
G. D. Toneva, R. J. Deierhoi, M. Morris, et al., “Oral antibiotic bowel preparation reduces length of stay and readmissions after colorectal surgery,” Journal of the American College of Surgeons, vol. 216, pp. 756–763, 2013.
[108]
K. M. F. Itani, S. E. Wilson, S. S. Awad, E. H. Jensen, T. S. Finn, and M. A. Abramson, “Polyethylene glycol versus sodium phosphate mechanical bowel preparation in elective colorectal surgery,” American Journal of Surgery, vol. 193, no. 2, pp. 190–194, 2007.
[109]
J. Long, O. Zaborina, C. Holbrook, A. Zaborin, and J. Alverdy, “Depletion of intestinal phosphate after operative injury activates the virulence of P aeruginosa causing lethal gut-derived sepsis,” Surgery, vol. 144, no. 2, pp. 189–197, 2008.
[110]
T. Ezri, E. Lerner, M. Muggia-Sullam et al., “Phosphate salt bowel preparation regimens alter perioperative acid-base and electrolyte balance,” Canadian Journal of Anesthesia, vol. 53, no. 2, pp. 153–158, 2006.
[111]
R. T. Lewis, R. G. Goodall, B. Marien, W. Lloyd-Smith, M. Park, and F. M. Wiegand, “Is neomycin necessary for bowel preparation in surgery of the colon? Oral neomycin plus erythromycin versus erythromycin-metronidazole,” Canadian Journal of Surgery, vol. 32, no. 4, pp. 265–270, 1989.
[112]
W. A. Altemeier, “The problem of postoperative wound infection and its significance,” Annals of Surgery, vol. 147, no. 5, pp. 770–774, 1958.
[113]
L. N. F. Aird and C. J. Brown, “Systematic review and meta-analysis of electrocautery versus scalpel for surgical skin incisions,” American Journal of Surgery, vol. 204, no. 2, pp. 216–221, 2012.
[114]
National Academy of Sciences, National Research Council, Division of Medical Sciences, and Ad Hoc Committee of Trauma, “Postoperative wound infection: the influence of ultraviolet irradiation of the operating room and of various other factors,” Annals of Surgery, vol. 160, pp. 1–192, 1964.
[115]
P. Gastmeier, A.-C. Breier, and C. Brandt, “Influence of laminar airflow on prosthetic joint infections: a systematic review,” Journal of Hospital Infection, vol. 81, no. 2, pp. 73–78, 2012.
[116]
R. J. Lynch, M. J. Englesbe, L. Sturm et al., “Measurement of foot traffic in the operating foom: implications for infection control,” American Journal of Medical Quality, vol. 24, no. 1, pp. 45–52, 2009.
[117]
T. A. Barbolt, “Chemistry and safety of triclosan, and its use as an antimicrobial coating on coated VICRYL. Plus antibacterial suture (coated polyglactin 910 suture with triclosan),” Surgical Infections, vol. 3, supplement 1, pp. S45–S53, 2002.
[118]
J. Baracs, O. Huszár, S. G. Sajjadi, and O. Peter Horváth, “Surgical site infections after abdominal closure in colorectal surgery using triclosan-coated absorbable suture (PDS Plus) vs. Uncoated sutures (PDS II): a randomized multicenter study,” Surgical Infections, vol. 12, no. 6, pp. 483–489, 2011.
[119]
W. K. Chang, S. Srinivasa, R. Morton, and A. G. Hill, “Triclosan-impregnated sutures to decrease surgical site infections: systematic review and meta-analysis of randomized trials,” Annals of Surgery, vol. 255, no. 5, pp. 854–859, 2012.
[120]
T. Nakamura, N. Kashimura, T. Noji, et al., “Triclosan-coated sutures reduce the incidence of wound infections and the costs after colorectal surgery: a randomized controlled trial,” Surgery, vol. 153, pp. 576–583, 2013.
[121]
Z. X. Wang, C. P. Jiang, Y. Cao, and Y. T. Ding, “Systematic review and meta-analysis of triclosan-coated sutures for the prevention of surgical-site infection,” British Journal of Surgery, vol. 100, pp. 465–473, 2013.
[122]
C. Justinger, J. E. Slotta, S. Ningel, et al., “Surgical-site infection after abdominal wall closure with triclosan-impregnated polydioxanone sutures: results of a randomized clinical pathway facilitated trial (NCT00998907),” Surgery, vol. 154, pp. 589–595, 2013.
[123]
G. T. Rodeheaver, D. Pettry, and J. G. Thacker, “Wound cleansing by high pressure irrigation,” Surgery Gynecology and Obstetrics, vol. 141, no. 3, pp. 357–362, 1975.
[124]
L. L. Maragakis, S. E. Cosgrove, X. Song et al., “An outbreak of multidrug-resistant Acinetobacter baumannii associated with pulsatile lavage wound treatment,” Journal of the American Medical Association, vol. 292, no. 24, pp. 3006–3011, 2004.
[125]
D. R. Knighton, B. Halliday, and T. K. Hunt, “Oxygen as an antibiotic. A comparison of the effects of inspired oxygen concentration and antibiotic administration on in vivo bacterial clearance,” Archives of Surgery, vol. 121, no. 2, pp. 191–195, 1986.
[126]
M. Qadan, C. Battista, S. A. Gardner, G. Anderson, O. Akca, and H. C. Polk, “Oxygen and surgical site infection: a study of underlying immunologic mechanisms,” Anesthesiology, vol. 113, no. 2, pp. 369–377, 2010.
[127]
R. Greif, O. Ak？a, E.-P. Horn, A. Kurz, and D. I. Sessler, “Supplemental perioperative oxygen to reduce the incidence of surgical- wound infection,” The New England Journal of Medicine, vol. 342, no. 3, pp. 161–167, 2000.
[128]
K. O. Pryor, T. J. Fahey III, C. A. Lien, and P. A. Goldstein, “Surgical site infection and the routine use of perioperative hyperoxia in a general surgical population: a randomized controlled trial,” Journal of the American Medical Association, vol. 291, no. 1, pp. 79–87, 2004.
[129]
F. J. Belda, L. Aguilera, J. García De La Asunción et al., “Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial,” Journal of the American Medical Association, vol. 294, no. 16, pp. 2035–2042, 2005.
[130]
O. Mayzler, N. Weksler, S. Domchik, M. Klein, S. Mizrahi, and G. M. Gurman, “Does supplemental perioperative oxygen administration reduce the incidence of wound infection in elective colorectal surgery?” Minerva Anestesiologica, vol. 71, no. 1-2, pp. 21–25, 2005.
[131]
C. Gardella, L. B. Goltra, E. Laschansky et al., “High-concentration supplemental perioperative oxygen to reduce the incidence of postcesarean surgical site infection: a randomized controlled trial,” Obstetrics and Gynecology, vol. 112, pp. 545–552, 2008.
[132]
P. S. Myles, K. Leslie, M. T. V. Chan et al., “Avoidance of nitrous oxide for patients undergoing major surgery: a randomized controlled trial,” Anesthesiology, vol. 107, no. 2, pp. 221–231, 2007.
[133]
C. S. Meyhoff, J. Wetterslev, L. N. Jorgensen et al., “Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial,” Journal of the American Medical Association, vol. 302, no. 14, pp. 1543–1550, 2009.
[134]
A. Bickel, M. Gurevits, R. Vamos, S. Ivry, and A. Eitan, “Perioperative hyperoxygenation and wound site infection following surgery for acute appendicitis : a randomized, prospective, controlled trial,” Archives of Surgery, vol. 146, no. 4, pp. 464–470, 2011.
[135]
M. S. Brar, S. S. Brar, and E. Dixon, “Perioperative supplemental oxygen in colorectal patients: a meta-analysis,” Journal of Surgical Research, vol. 166, no. 2, pp. 227–235, 2011.
[136]
A. Al-Niaimi and N. Safdar, “Supplemental perioperative oxygen for reducing surgical site infection: a meta-analysis,” Journal of Evaluation in Clinical Practice, vol. 15, no. 2, pp. 360–365, 2009.
[137]
J. C. Chura, A. Boyd, and P. A. Argenta, “Surgical site infections and supplemental perioperative oxygen in colorectal surgery patients: a systematic review,” Surgical Infections, vol. 8, no. 4, pp. 455–461, 2007.
[138]
M. Qadan, O. Ak？a, S. S. Mahid, C. A. Hornung, and H. C. Polk Jr., “Perioperative supplemental oxygen therapy and surgical site infection a meta-analysis of randomized controlled trials,” Archives of Surgery, vol. 144, no. 4, pp. 359–366, 2009.
[139]
L. S. Kao, S. G. Millas, C. Pedroza, et al., “Should perioperative supplemental oxygen be routinely recommended for surgery patients?” Annals of Surgery, vol. 256, pp. 894–901, 2012.
[140]
A. Kurz, D. I. Sessler, and R. Lenhardt, “Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization,” The New England Journal of Medicine, vol. 334, no. 19, pp. 1209–1215, 1996.
[141]
S. J. Lehtinen, G. Onicescu, K. M. Kuhn, D. J. Cole, and N. F. Esnaola, “Normothermia to prevent surgical site infections after gastrointestinal surgery: holy grail or false idol?” Annals of Surgery, vol. 252, no. 4, pp. 696–703, 2010.
[142]
G. B. Melton, J. D. Vogel, B. R. Swenson, et al., “Continuous intraoperative temperature measurement and surgical site infection: analysis of anesthesia information system data in 1008 colorectal procedures,” Annals of Surgery, vol. 258, pp. 606–613, 2013.
[143]
A. P. Furnary, K. J. Zerr, G. L. Grunkemeier, and A. Starr, “Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures,” Annals of Thoracic Surgery, vol. 67, no. 2, pp. 352–362, 1999.
[144]
R. Latham, A. D. Lancaster, J. F. Covington, J. S. Pirolo, and J. Thomas C.S., “The association of diabetes and glucose control with surgical-site infections among cardiothoracic surgery patients,” Infection Control and Hospital Epidemiology, vol. 22, no. 10, pp. 607–612, 2001.
[145]
M. Turina, D. E. Fry, and H. C. Polk Jr., “Acute hyperglycemia and the innate immune system: clinical, cellular, and molecular aspects,” Critical Care Medicine, vol. 33, no. 7, pp. 1624–1633, 2005.
[146]
Y. J. McConnell, P. M. Johnson, and G. A. Porter, “Surgical site infections following colorectal surgery in patients with diabetes: association with postoperative hyperglycemia,” Journal of Gastrointestinal Surgery, vol. 13, no. 3, pp. 508–515, 2009.
[147]
S. O. Rogers, M. Ramos, Z. Khalpey et al., “Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery,” Annals of Surgery, vol. 248, no. 4, pp. 585–590, 2008.
[148]
S. Kwon, R. Thompson, P. Dellinger, et al., “Importance of perioperative glycemic control in general surgery: a report from the surgical care and outcomes assessment program,” Annals of Surgery, vol. 257, pp. 8–14, 2013.
[149]
F. A. Coller and W. L. Valk, “The delayed primary closure of contaminated wounds,” Annals of Surgery, vol. 112, pp. 256–262, 1940.
