Surgical site infections more likely in patients with history of skin infection

May 30, 2012

People with a past history of just a single skin infection may be three times more likely to develop a painful, costly -- and potentially deadly -- surgical site infection (SSI) when they have an operation, according to new Johns Hopkins research.

The increased risk, described online in the Annals of Surgery, suggests there are underlying biological differences in the way individuals respond to skin cuts that need to be better understood in order to prevent SSIs, the researchers say. Even when all of the proper procedures known to prevent SSIs are followed -- from administering preoperative antibiotics to using the correct antiseptic to prepare the skin during surgery -- some patients appear to be much more susceptible than others to contracting an infection, they add.

Although the research does not establish a cause-and-effect relationship between a past skin infection and SSI, the research team says the association between them is strong and should not be ignored.

"What this research suggests is that people have intrinsic differences in how susceptible they are to infection and that we need to know their skin infection histories," says study leader Nauder Faraday, M.D., M.P.H., an associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. "Now that we have these findings, we must learn more about the exact molecular basis for the difference and develop new strategies to prevent harm."

Each year, an estimated 500,000 patients in the United States develop SSIs, which are responsible for more than 10,000 deaths, disability and decreased quality of life. SSIs result in longer hospital stays, readmissions and subsequent treatment, and cost the health care system billions of dollars a year. As a result, reducing these complications has become a national priority. The Centers for Medicare and Medicaid Services (CMS) considers many SSIs to be preventable and has begun to refuse covering the cost of additional care related to SSIs after some cardiac and orthopedic procedures.

In their study, Faraday and his colleagues analyzed information before, during and after surgery for 613 patients, with an average age of 62. The operations they underwent included cardiac surgery, vascular surgery, neurosurgery or spinal surgery and all were followed for six months after their procedures, performed at The Johns Hopkins Hospital and the University of Maryland Medical Center between Feb. 1, 2007 and Aug. 20, 2010. Some 22 percent had a history of skin infection.

Twenty-four patients developed an SSI within 180 days of surgery, and five of them died from the condition. Another 15 died from noninfectious causes. Of those who had a history of skin infection, 6.7 percent got an SSI compared with 3.9 percent of those without a history of skin disease. It made no difference whether the skin infection was recent or had occurred years earlier. Researchers also took into account and adjusted for other known risk factors for SSI, including the patient's age, a diagnosis of diabetes and some medications they were taking.

Faraday says it is logical that someone with a history of skin infection could be more likely to get an infection after surgery. The same types of bacteria that cause such skin infections as abscesses, impetigo or cellulitis, he says, are the same types of bacteria known to cause wound infections in the operations that were studied. When someone's immune system responds to exposure to these bugs by developing an infection, it makes sense that the person might have the same reaction when taxed again in a similar way during surgery. Infectious agents can be present or enter even thoroughly cleaned and sterilized hospital environments.

"People are exposed to bacteria and viruses all the time," Faraday says, but even those exposed to the same pathogens respond differently. "Your neighbor may come down with pneumonia and you won't, even if exposed at the same time to the same germs. Everyone is different and if we treat everyone as though they're the same, we will never get the risk level to zero."

Faraday says if his results are right and individual differences in biology account for some SSI risk, then penalties imposed on hospitals that fail to prevent SSIs may be at least partly premature. It's clear, he says, that at least a portion of these infections may occur regardless of current infection-control standards, including those recommended by the Centers for Disease Control and Prevention. Given the lack of knowledge about the origins of individual differences in risk, he says there is reason for concern that CMS considers many SSIs to be completely preventable.

"The problem with financial penalties instituted by CMS is that it implies we know everything about how to prevent surgical site infections and if we just do the right thing, we won't have complications," he says. "There's no doubt we can and should do better, but we won't eliminate infections with the knowledge and treatments we have now. There's still a lot to learn if we want to reach our goal of zero complications."
-end-
This research was supported in part by the National Institutes of Health's National Center for Research Resources and National Center for Advancing Translational Sciences (M01-RR000052).

Other Johns Hopkins researchers who contributed to this study include Elaina E. Lin, M.D.; Trish M. Perl, M.D., M.Sc.; Karen Carroll, M.D.; Tracey Stierer, M.D.; Polly Robarts, B.A.; Angela McFillin, B.S.; Tracy Ross, B.S.; Ashish S. Shah, M.D.; Lee H. Riley, M.D.; Rafael J. Tamargo, M.D.; James H. Black, M.D.; Elena Blasco-Colmenares, M.D., Ph.D.; and Eliseo Guallar, M.D., Dr.PH.

For more information: http://www.hopkinsmedicine.org/anesthesiology_critical_care_medicine/research/experts/research_faculty/bios/faraday.html

Johns Hopkins Medicine

Related Infection Articles from Brightsurf:

Halving the risk of infection following surgery
New analysis by the University of Leeds and the University of Bern of more than 14,000 operations has found that using alcoholic chlorhexidine gluconate (CHG) halves the risk of infection in certain types of surgery when compared to the more commonly used povidone-iodine (PVI).

How plants shut the door on infection
A new study by an international team including University of Maryland scientists has discovered the key calcium channel responsible for closing plant pores as an immune response to pathogen exposure.

Sensing infection, suppressing regeneration
UIC researchers describe an enzyme that blocks the ability of blood vessel cells to self-heal.

Boost to lung immunity following infection
The strength of the immune system in response to respiratory infections is constantly changing, depending on the history of previous, unrelated infections, according to new research from the Crick.

Is infection after surgery associated with increased long-term risk of infection, death?
Whether experiencing an infection within the first 30 days after surgery is associated with an increased risk of another infection and death within one year was the focus of this observational study that included about 660,000 veterans who underwent major surgery.

Revealed: How E. coli knows how to cause the worst possible infection
The discovery could one day let doctors prevent the infection by allowing E. coli to pass harmlessly through the body.

UK study shows most patients with suspected urinary tract infection and treated with antibiotics actually lack evidence of this infection
New research presented at this week's European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Amsterdam, Netherlands (April 13-16, 2019) shows that only one third of patients that enter the emergency department with suspected urinary tract infection (UTI) actually have evidence of this infection, yet almost all are treated with antibiotics, unnecessarily driving the emergence of antimicrobial resistance.

Bacteria in urine doesn't always indicate infection
Doctors should think carefully before testing patients for a urinary tract infection (UTI) to avoid over-diagnosis and unnecessary antibiotic treatment, according to updated asymptomatic bacteriuria (ASB) guidelines released by the Infectious Diseases Society of America (IDSA) and published in Clinical Infectious Diseases.

Subsidies for infection control to healthcare institutions help reduce infection levels
Researchers compared three types of infection control subsidies and found that under a limited budget, a dollar-for-dollar matching subsidy, in which policymakers match hospital spending for infection control measures, was the most effective at reducing the number of hospital-acquired infections.

Dengue virus infection may cause severe outcomes following Zika virus infection during pregnancy
This study is the first to report a possible mechanism for the enhancement of Zika virus progression during pregnancy in an animal model.

Read More: Infection News and Infection Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.