Current outcomes and predictors of treatment failure in patients with surgical site infection after elective colorectal surgery. A multicentre prospective cohort study.
To determine current outcomes and predictors of treatment failure among patients with surgical site infection (SSI) after colorectal surgery.



A multicentre observational prospective cohort study of adults undergoing elective colorectal surgery in 10 Spanish hospitals (2011-2014). Treatment failure was defined as persistence of signs/symptoms of SSI or death at 30 days post-surgery.



Of 3701 patients, 669 (18.1%) developed SSI; 336 (9.1%) were organ-space infections. Among patients with organ-space SSI, 81.2% required source control: 60.4% reoperation and 20.8% percutaneous/transrectal drainage. Overall treatment failure rate was 21.7%: 9% in incisional SSIs and 34.2% in organ-space SSIs (p < 0.001). Median length of stay was 15 days (IQR 9-22) for incisional SSIs and 24 days (IQR 17-35) for organ-space SSIs (p < 0.001). One hundred and twenty-seven patients (19%) required readmission and 35 patients died (5.2%). Risk factors for treatment failure among patients with organ-space SSI were age ≥65 years (OR 1.83, 95% CI: 1.07-1.83), laparoscopy (OR 1.7, 95% CI: 1.06-2.77), and reoperation (OR 2.8, 95% CI: 1.7-4.6).



Rates of SSI and treatment failure in organ-space SSI after elective colorectal surgery are notably high. Careful attention should be paid to older patients with previous laparoscopy requiring reoperation for organ-space SSI, so that treatment failure can be identified early.
Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; VINCat Program, Spain. Electronic address: agomilagrange@gmail.com.
Aina
A
Gomila
Department of General Surgery, Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, Spain; VINCat Program, Spain. Electronic address: jmbadia@fhag.es.
Josep Ma
JM
Badia
Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; VINCat Program, Spain; University of Barcelona, Barcelona, Spain. Electronic address: jcarratala@bellvitgehospital.cat.
Jordi
J
Carratalà
Department of Surgery and Infection Control Team, Corporació Sanitària Parc Taulí, Barcelona, Spain; VINCat Program, Spain. Electronic address: jserraa@tauli.cat.
Xavier
X
Serra-Aracil
Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; VINCat Program, Spain. Electronic address: eshawp@gmail.com.
Evelyn
E
Shaw
Department of Infectious Diseases, Parc Sanitari Sant Joan de Déu de Sant Boi, Barcelona, Spain. Electronic address: vicente.diaz@pssjd.org.
Vicens
V
Diaz-Brito
Department of Internal Medicine, Hospital Universitari Sant Joan de Reus, Tarragona, Spain; VINCat Program, Spain. Electronic address: antoni.castro@urv.cat.
Antoni
A
Castro
Department of Infectious Diseases, Consorci Sanitari de Terrassa, Barcelona, Spain; VINCat Program, Spain. Electronic address: 12088eea@comb.cat.
Elena
E
Espejo
Department of Infectious Diseases, Hospital Universitari Mútua de Terrassa, Barcelona, Spain; VINCat Program, Spain. Electronic address: mcnicolas@mutuaterrassa.cat.
Carmen
C
Nicolás
Department of Surgery and Infection Control Team, Corporació Sanitària Parc Taulí, Barcelona, Spain; VINCat Program, Spain. Electronic address: mpiriz@tauli.cat.
Marta
M
Piriz
Department of Internal Medicine, Consorci Sanitari de l'Anoia, Barcelona, Spain; VINCat Program, Spain. Electronic address: mbrugues@csa.cat.
Montserrat
M
Brugués
Department of Internal Medicine, Fundació Althaia, Barcelona, Spain; VINCat Program, Spain. Electronic address: jobradors@althaia.cat.
Josefina
J
Obradors
Department of Internal Medicine, Hospital de Viladecans, Barcelona, Spain; VINCat Program, Spain. Electronic address: alerida@gencat.cat.
Ana
A
Lérida
Department of General Surgery, Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, Spain; VINCat Program, Spain. Electronic address: jcuquet@fhag.es.
Jordi
J
Cuquet
VINCat Program, Spain. Electronic address: elimon@bellvitgehospital.cat.
Enric
E
Limón
VINCat Program, Spain; University of Barcelona, Barcelona, Spain. Electronic address: fgudiol@bellvitgehospital.cat.
Francesc
F
Gudiol
Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; VINCat Program, Spain. Electronic address: mpujol@bellvitgehospital.cat.
Miquel
M
Pujol
D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D060085:Coinfection / Q000188:drug therapy; D003107:Colorectal Surgery / Q000009:adverse effects* / Q000401:mortality; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000188:drug therapy*; D017211:Treatment Failure; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents
Colorectal diseases; Multidrug-resistant Gram-negative bacilli; Organ-space surgical site infections; Surgical site infections