Turkish surgical infections

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Surgical Site Infections Turkish Perspective


Arda Isik1*, Gultekin Ozan Kucuk2, Durkaya Oren1

1:Erzincan Binali Yildirim University, School of Medicine, General Surgery Department, Erzincan, Turkey

2:University of Health Sciences, Samsun Education and Research Hospital, General Surgery Department, Samsun, Turkey

*:corresponding author,  kararda@yahoo.com

Surgical site infections (SSI) and sepsis remain an important issue and are frequently encountered as nosocomial infections in daily surgical practice (1). Minimally invasive techniques have become widespread in surgical applications and SSIs are less common compared to conventional applications. In Turkey, studies on the treatment of SSIs and educational interventions for reducing the incidence of these infections are continuing in many centers, including the Ministry of Health and University hospitals (2). The Turkish Republic Ministry of Health has studies and national projects on the prevention of SSIs with patient safety protocols and education of health providers about rational use of drugs. These studies are controlled by the Ministry of Health Scientific Advisory Board and sub-committees, which were established on a provincial basis. The aim of this committee is to prevent antibiotic resistance in organisms that cause SSIs and to draw attention to the importance of drug use especially in geriatric patients. In the sub-groups, infection prevention and control committees were established in hospitals and these committees organize meetings at hospitals at regular intervals to discuss the outcomes of SSIs. Additionally, training sessions and educational interventions are held in general surgery clinics to prevent SSIs. National congresses and meetings are organized on this subject and these meetings are held periodically. Additionally, educational modules have been created by the Turkish Surgical Society that have been made available to all surgical specialists and residencies to reduce SSIs using evidence-based methods (3). In a multicenter study, antibiotic use was incompatible with guidelines even in tertiary hospitals in Turkey (4). In this study, the type of antibiotic was inappropriate in 66 (40.9%) patients and the duration of use was inappropriate in 47 (29.1%) patients. Another study from Turkey showed that the most frequent mistake (82.8%) was more prolonged use of prophylactic antibiotics than required (5).

In Turkey, we have problems similar to the rest of the world with respect to infectious diseases and their management. Complicated intraabdominal infections due to luminal organ perforations, open abdomen management, infection, and sepsis control after post-operative fistulas and acute pancreatitis in young patients are still important issues and are still associated with serious complications. Additionally, intraabdominal infections due to blunt and penetrating trauma are encountered in daily surgical emergencies and are still focused problems. The follow-up and treatment of these patients, especially in intensive care units, is carried out in cooperation with intensive care specialists. The fact that intensive care expertise has been accepted as a formal fellowship after general surgery in Turkey is important for the follow-up and evaluation of these patients by general surgeons, who have extra and specialized knowledge in that area. Obesity surgery, which is a surgical procedure frequently performed with an increasing rate, and its infectious complications especially after revisional bariatric surgery is another topic of focus for surgical site infection (SSI) management. On the other hand, Turkey differs from other countries due to a high incidence of hydatid disease and its infectious complications. Infections such as necrotizing fasciitis and Clostridium difficile colitis are seen, especially in patients receiving prolonged antibiotic and immunosuppressive drug treatment and in patients with uncontrolled diabetes mellitus(6). Beside this, the establishment of palliative intensive care centers in university hospitals and SSIs, which encounter these types of patients, is another main topic of focus topic in hospitals. Infections in patients under the treatment chemotherapy and radiotherapy are also encountered in Turkey even after months of surgery. In addition, one of the first difficulties in management of SSIs is the lack of adequate organized radiological support with minimally invasive techniques in many hospitals. University hospitals and some specialized hospitals particularly have notable advantages with respect to this type of equipment over other hospitals.

In Turkey, besides these problems, there has been successful implementation of rational drug use by following the recommendations of the World Health Organization aimed at preventing unnecessary antibiotic use, combating polypharmacy, mandatory educations in Congress programs with continuous medical education lectures, application of minimally invasive techniques in surgical procedures, shortening the length of hospital stay, and application of enhanced recovery after surgery (ERAS) protocols.

In conclusion, SSI and nutrition, standardization of antibiotic prophylaxis against common microbial pathogens in surgical practice, anastomotic leakage and advances in source control, patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for advanced stage tumors, patients in palliative care units, management of infectious diseases geriatric patients, and significance of host microbiata (such as microbiata transfer for treatment of diseases such as C. difficile colitis in patients receiving antibiotic treatment in intensive care unit)  are among the current ongoing  discussed issues. The Ministry of Health, University and Education and Research hospitals and other centers continue their education and research activities with respect to SSI prevention and management.

  1. Weiser, T. G., Forrester, J. D., Forrester, J. A. (2019). Tactics to Prevent Intra-Abdominal Infections in General Surgery. Surgical doi:10.1089/sur.2018.282
  2. Avkan-Oguz V, Baykam N, Sokmen S, et al. Recommendations for intraabdominal infections consensus report. Ulus Cerrahi Derg 2016;32: 306–21.
  3. http://sneg.turkcer.org.tr/course/content/313
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  6. Sartelli et al. World Journal of Emergency Surgery (2018) 13:37 https://doi.org/10.1186/s13017-018-0198-x