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Surgical Site Infections: Wound and Stump Infections

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Principles and Practice of Transplant Infectious Diseases

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Abstract

Surgical site infections (SSIs) following transplantation have been linked to increased mortality, graft rejection, increased length of stay, and increased resource utilization ). Rates of SSI vary and can reach as high as 37% for some transplant procedures . The risk of infection depends greatly on type of surgery and patient-specific factors. Postoperative wound infections following transplant generally occur within 30 days of surgery and can range from superficial to organ/space involvement. A number of factors predispose transplant patients to SSI including immunosuppression, reoperation, diabetes, and obesity . The route of infection is dependent on type of transplant surgery and may be both endogenous and exogenous . Microorganisms in posttransplant SSIs are primarily bacterial; however, fungal infections may also play a role . Multidrug-resistant organisms are becoming an increasingly common culprit of SSI in this population due to a heavy exposure to the healthcare system, use of prophylactic antibiotics, and immunosuppression. There are few guidelines to direct therapy. In general, management with debridement alone is not sufficient in the transplant population, due to impaired host defenses. Culture or PCR of tissues is critical to diagnose resistant or unexpected pathogens. Depending upon local epidemiology and site of infection, antibiotics to target resistant Gram-positive and Gram-negative organisms (including Pseudomonas), Candida, and, on occasion, Aspergillus, may be necessary. Measures to prevent SSI during the preoperative, intraoperative, and postoperative period should be evidence-based and incorporated into hospital quality control initiatives.

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Authors and Affiliations

  1. Section of Infectious Diseases, Department of Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, and the William S. Middleton Memorial Veterans Hospital, Madison, WI, USA

    Nasia Safdar

  2. UnityPoint Health-Meriter, Department of Performance Improvement, Madison, WI, USA

    Sara A. M. Zerbel

  3. Division of Infectious Diseases, Department of Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA

    Elizabeth Ann Misch

Authors
  1. Nasia Safdar
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  2. Sara A. M. Zerbel
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  3. Elizabeth Ann Misch
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Correspondence to Nasia Safdar .

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Editors and Affiliations

  1. Clinical Associate Professor of Medicine, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, USA

    Amar Safdar

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Safdar, N., Zerbel, S.A.M., Misch, E.A. (2019). Surgical Site Infections: Wound and Stump Infections. In: Safdar, A. (eds) Principles and Practice of Transplant Infectious Diseases. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-9034-4_14

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  • DOI: https://doi.org/10.1007/978-1-4939-9034-4_14

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