Management of Surgical Site Infections

Publication Date: June 9, 2018

RECOMMENDATIONS

MEDICAL IMAGING

Limited evidence supports the use of medical imaging in the diagnostic evaluation of patients with a suspected organ/space (i.e. bone, joint, and implant) surgical site infection. (L)
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CULTURES

Strong evidence supports that synovial fluid and tissue cultures are strong rule-in tests for the diagnosis of infection; negative synovial fluid and tissue cultures do not reliably exclude infection. (S)
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C-REACTIVE PROTEIN

Strong evidence supports that C-reactive Protein is a strong rule-in and rule-out marker for patients with suspected surgical site infections. (S)
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ERYTHROCYTE SEDIMENTATION RATE

Limited strength evidence does not support the use of ESR, alone, to rule in and rule out surgical site infections due to conflicting data. (L)
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CLINICAL EXAM FOR THE DIAGNOSIS OF SURGICAL SITE INFECTIONS

Moderate strength evidence supports that clinical exam (i.e. pain, drainage, fever) is a moderate to strong rule-in test (i.e. high probability of presence of infection, if test is positive) for patients with suspected surgical site infections, but a weak rule-out test. (M)
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STRONG EVIDENCE OF FACTORS ASSOCIATED WITH INCREASED RISK OF SSI

Strong evidence supports that the following factors are associated with an increased risk of infection:
  • Anemia
  • Duration of Hospital Stay
  • Immunosuppressive Medications
  • History of Alcohol Abuse
  • Obesity
  • Depression
  • History of Congestive Heart Failure
  • Dementia
  • HIV/AIDS
(S)
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MODERATE EVIDENCE OF INCREASED ASSOCIATED RISK OF SSI

Moderate strength evidence supports that patients with chronic kidney disease are at an increased risk of infection after hip and knee arthroplasty. (M)
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LIMITED EVIDENCE OF INCREASED ASSOCIATED SSI RISK

Limited strength evidence supports that patients meeting one or more of the following criteria are at an increased risk of infection after hip and knee arthroplasty:
  • Diabetes (conflicting evidence)
  • Tobacco Use/Smoking (conflicting evidence)
  • Cancer (conflicting evidence)
  • Hypertension (conflicting evidence)
  • Liver Disease (conflicting evidence)
  • Malnutrition (conflicting evidence)
(L)
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ANTIBIOTIC DURATION FOR MANAGEMENT OF SURGICAL SITE INFECTIONS

Moderate evidence supports that, in the setting of retained total joint arthroplasty, antibiotic protocols of 8 weeks do not result in significantly different outcomes when compared to protocols of 3 to 6-month duration. (M)
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RIFAMPIN USE FOR MANAGEMENT OF SURGICAL SITE INFECTIONS

Moderate evidence supports that rifampin, as a second antimicrobial, increases the probability of treatment success for staphylococcal infections in the setting of retained orthopaedic implants. (M)
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Recommendation Grading

Disclaimer

Overview

Title

Management of Surgical Site Infections

Authoring Organization

Endorsing Organizations

Publication Month/Year

June 9, 2018

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Adult, Older adult

Health Care Settings

Ambulatory, Emergency care, Home health, Hospital, Long term care, Operating and recovery room, Outpatient

Intended Users

Physical therapist, occupational therapist, nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis, Rehabilitation, Prevention, Management, Treatment

Supplemental Methodology Resources

Systematic Review Document