Federico Coccolini1, Mario Improta2, Enrico Cicuttin3, Fausto Catena4, Massimo Sartelli5, Raffaele Bova2, Nicola De' Angelis6,7, Stefano Gitto8, Dario Tartaglia3, Camilla Cremonini3, Carlos Ordonez9, Gian Luca Baiocchi10, Massimo Chiarugi3. 1. General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa 1, 56100, Pisa, Italy. Federico.coccolini@gmail.com. 2. General Surgery Department, Bologna University Hospital, Bologna, Italy. 3. General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa 1, 56100, Pisa, Italy. 4. Emergency Surgery Department, Parma University Hospital, Parma, Italy. 5. General Surgery Department, Macerata Hospital, Macerata, Italy. 6. Unit of Digestive and Hepato-biliary-pancreatic Surgery, Henri Mondor Hospital, Créteil, France. 7. UPEC, University Paris Est, Créteil, France. 8. Department of Experimental and Clinical Medicine, Firenze University, Firenze, Italy. 9. Department of Surgery, Fundación Valle del Lili, Cali, Colombia. 10. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Abstract
BACKGROUND: Immunocompromised patients are at higher risk of surgical site infection and wound complications. However, optimal management in the perioperative period is not well established. Present systematic review aims to analyse existing strategies and interventions to prevent and manage surgical site infections and other wound complications in immunocompromised patients. METHODS: A systematic review of the literature was conducted. RESULTS: Literature review shows that partial skin closure is effective to reduce SSI in this population. There is not sufficient evidence to definitively suggest in favour of prophylactic negative pressure wound therapy. The use of mammalian target of rapamycin (mTOR) and calcineurin inhibitors (CNI) in transplanted patient needing ad emergent or undeferrable abdominal surgical procedure must be carefully and multidisciplinary evaluated. The role of antibiotic prophylaxis in transplanted patients needs to be assessed. CONCLUSION: Strict adherence to SSI infection preventing bundles must be implemented worldwide especially in immunocompromised patients. Lastly, it is necessary to elaborate a more widely approved definition of immunocompromised state. Without such shared definition, it will be hard to elaborate the needed methodologically correct studies for this fragile population.
BACKGROUND: Immunocompromised patients are at higher risk of surgical site infection and wound complications. However, optimal management in the perioperative period is not well established. Present systematic review aims to analyse existing strategies and interventions to prevent and manage surgical site infections and other wound complications in immunocompromised patients. METHODS: A systematic review of the literature was conducted. RESULTS: Literature review shows that partial skin closure is effective to reduce SSI in this population. There is not sufficient evidence to definitively suggest in favour of prophylactic negative pressure wound therapy. The use of mammalian target of rapamycin (mTOR) and calcineurin inhibitors (CNI) in transplanted patient needing ad emergent or undeferrable abdominal surgical procedure must be carefully and multidisciplinary evaluated. The role of antibiotic prophylaxis in transplanted patients needs to be assessed. CONCLUSION: Strict adherence to SSI infection preventing bundles must be implemented worldwide especially in immunocompromised patients. Lastly, it is necessary to elaborate a more widely approved definition of immunocompromised state. Without such shared definition, it will be hard to elaborate the needed methodologically correct studies for this fragile population.
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