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Canine
Chronic wound
Punctures

CPD article: Biofilms and surgical site infections

02 March 2022
Features
02 March 2022
Volume 27 · Issue 3
Figure 1. Superficial incisional surgical site infection after exploratory laparotomy.
Figure 1. Superficial incisional surgical site infection after exploratory laparotomy.

Abstract

Surgical site infections are common in small animal veterinary practice, and can result in increased morbidity and mortality as well as adding to overall healthcare costs. Surgical site infections are nosocomial infections and can be classified as superficial incisional, deep incisional, or organ-space. Biofilm-producing bacteria in surgical site infections have survival advantages compared to sessile bacteria, making diagnosis and treatment more challenging. Treatment of surgical site infections varies and depends on the type of infection, drug susceptibility, patient factors and wound factors. Preoperative, intraoperative, and postoperative measures can be taken to prevent the development of surgical site infections. Surgical materials to reduce the likelihood of biofilm formation have been developed, but strong evidence to support their use is lacking. Further prospective veterinary studies and the development of active veterinary surveillance programmes are warranted.

Surgical site infections are common in small animal veterinary practice and will have been encountered by most, if not all, practitioners. Well-established surveillance programmes in human medicine estimate the incidence of surgical site infections to be about 2.0–2.8% (Barie, 2002; de Lissovoy et al, 2009). Comprehensive surveillance is lacking in veterinary medicine; various studies report incidences ranging from 2.5–18.1% (Vasseur et al, 1988; Eugster et al, 2004). The significant variation is attributable to differences in surveillance methodology, difference in procedures undertaken, and large variation in degree of wound contamination (Turk et al, 2014).

Surgical site infections result in significant patient morbidity and mortality, including but not limited to pain, prolonged wound management, the need for revision surgery, increased antimicrobial use, patient death or euthanasia (Stetter et al, 2021). From an economic standpoint, surgical site infections can double the cost of hospital stays in human patients (Broex et al, 2009). A single-centre veterinary study observed an increase in total and postsurgical costs of 74.4% and 142.2% respectively in cases of surgical site infections (Espinel-Rupérez et al, 2019). In veterinary medicine, which is largely privately-funded, the financial implications of surgical site infections on clients should not be overlooked.

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biofilm
nosocomial infection
surgical site infection
triclosan
veterinary surgery