Open AccessAAOS Systematic Literature Review: Summary on the Management of Surgical Site Infections
Author(s) -
Andrew McLaren,
Douglas W. Lundy
Publication year - 2019
Publication title -
journal of the american academy of orthopaedic surgeons
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.343
H-Index - 111
eISSN - 1095-8762
pISSN - 1067-151X
DOI - 10.5435/jaaos-d-18-00653
Subject(s) - medicine , intensive care medicine , medline , surgical infections , anemia , intervention (counseling) , surgery , antibiotics , psychiatry , political science , law , microbiology and biotechnology , biology
The purpose of this systematic review is to improve outcomes for the care of surgical site infections by presenting the current best evidence on important diagnostic and care issues. The findings led to ten recommendations and five consensus statements that address diagnosis and treatment of orthopaedic surgical site infections. There is strong evidence to supports anemia, obesity, HIV/AIDS, depression, dementia, immunosuppressive medications, duration of hospital stay, history of alcohol abuse, and history of congestive heart failure as factors that increased the risk of infection, some of which are modifiable before surgical intervention. Diagnostically, synovial fluid and tissue cultures were found to be strong "rule-in" tests for the diagnosis of infection, but negative synovial fluid and tissue cultures do not reliably exclude infection. C-reactive protein was found to be a strong rule-in and rule-out marker for patients with suspected surgical site infections. Therapeutically, only for patients with retained implants, antimicrobial protocols of 8 weeks of duration were found to be associated with outcomes that are not inferior to outcomes from protocols of 3- to 6-month duration. Also only for patients with retained implants, rifampin, used as a second antimicrobial, increases the probability of treatment success for staphylococcal infections. The surgical site infection work group identified a lack of high-level outcomes data, highlighting the need for high-quality clinical trials in the treatment of surgical site infections.