International Consensus on Management of Superficial and Deep Surgical Site Infections
Overview
Surgical site infections (SSIs) remain a significant challenge in acute care, accounting for 18.4% of infections and causing substantial morbidity and mortality. A modified Delphi process involving 52 European experts achieved consensus on key aspects of SSI epidemiology, management, consequences, and antibiotic therapy, highlighting the importance of multidisciplinary approaches and local epidemiology knowledge.
Background
SSIs are common healthcare-associated infections with an incidence comparable to hospital-acquired pneumonia and urinary tract infections, resulting in over 16,000 deaths annually. Risk varies by surgery type, with higher rates in emergency and intra-abdominal procedures, and among immunosuppressed, obese, and diabetic patients. Pathogens typically reflect the surgical site flora, with Staphylococcus aureus and Gram-negative bacteria being common. Surveillance and post-discharge monitoring are critical for accurate SSI detection and management.
Data Highlights
A meta-analysis of 1.4 million surgeries across 15 countries identified 141,347 SSIs, with 60.1% occurring after hospital discharge. The Delphi survey achieved a 58% response rate from 52 experts across five European countries, reaching consensus on 62 of 73 questionnaire items related to SSI management.
Key Findings
SSIs constitute 18.4% of all acute care-associated infections with significant mortality.
Risk factors include type and duration of surgery, emergency procedures, and patient comorbidities such as immunosuppression, obesity, and diabetes.
Common pathogens are site-specific commensals, predominantly Staphylococcus aureus and Gram-negative Enterobacteriaceae after abdominal surgeries.
Antimicrobial-resistant pathogens in SSIs increase hospitalization length and costs.
Institutional surveillance and patient self-assessment post-discharge improve SSI detection and management.
A multidisciplinary team approach is essential, requiring familiarity with local epidemiology and antimicrobial resistance patterns.
Clinical Implications
Clinicians should prioritize SSI risk stratification based on surgery type and patient factors, utilize local surveillance data to guide management, and implement multidisciplinary strategies for prevention and treatment. Awareness of antimicrobial resistance patterns is crucial for effective antibiotic therapy. Post-discharge monitoring, including validated patient questionnaires, is important for timely SSI identification.
Conclusion
This expert consensus underscores the complexity of SSI management and the necessity of coordinated, evidence-based approaches tailored to local epidemiology and patient risk profiles to reduce SSI burden and improve outcomes.
References
International Consensus on the Management of Superficial and Deep Surgical Site Infections, 2020
