ESBL-B before colorectal surgery ups risk of surgical site infection

MADRID – Patients who are carriers of extended-spectrum beta lactamase–producing Enterobacteriaceae (ESBL-B) before colorectal surgery are at more than double the risk of surgical site infection, despite a standard prophylactic antibiotic regimen.

Surgical site infections (SSIs) occurred in 23% of those who tested positive for the pathogens preoperatively, compared with 10.5% of ESBL-B–negative patients – a significant increased risk of 2.25, Yehuda Carmeli, MD, said at the European Congress of Clinical Microbiology and Infectious Diseases annual congress.

ESBL-B was not the infective pathogen in most infection cases, but being a carrier increased the likelihood of an ESBL-B SSI. ESBL-B was the pathogen in 7.2% of the carriers and 1.6% of the noncarriers. However, investigators are still working to determine if the species present in the wound infection are the same as the ones present at baseline, said Dr. Carmeli of Tel Aviv Medical Center.

^{CDC/James Arche/Illustrators: Alissa Eckert and Jennifer Oosthuizen}

But clearly, he said, the presence of ESBL-B before colorectal surgery is a risk that can’t be ignored – and that can’t be reduced with traditional preoperative precautions. A better alternative for these patients would most likely be a carbapenem. Dr. Carmeli’s colleague, Amir Nutman, MD, explored this idea in a related study, which also was presented at the meeting. It determined that ertapenem was a much better choice, cutting surgical site infections by 41% in ESBL-B carriers

All of these results are emerging from the WP4 study, which was carried out in three hospitals in Serbia, Switzerland, and Israel. Designed as a before-and-after trial, it tested the theory that identifying ESBL carriers and targeting presurgical antibiotic prophylaxis could improve their surgical outcomes.

WP4 was one of five studies in the multinational R-GNOSIS project. “Resistance in Gram-Negative Organisms: Studying Intervention Strategies” is a 12-million-euro, 5-year European collaborative research project designed to identify effective interventions for reducing the carriage, infection, and spread of multi-drug resistant Gram-negative bacteria. From 2012 to 2017, WP4 enrolled almost 4,000 adults scheduled to undergo colorectal surgery (excluding appendectomy or minor anorectal procedures).

Several of the studies were reported at ECCMID 2018.

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