Infections following Tissue Expander Placement: Is the CDC definition enough?
Heather Saunders, RN, MPH, Charalampos Siotos, MD, Jill Stone, MD, Michele A. Manahan, MD, Carisa M. Cooney, MPH, Gedge D. Rosson, MD.
Johns Hopkins University, Baltimore, MD, USA.
PURPOSE: According to the CDC/NHSN, the surgical site infection (SSI) surveillance period ends at 90-days post-operatively or when there is invasive manipulation of the surgical site. In the case of tissue expanders (TEs) post-mastectomy, the SSI surveillance period ends when an expander is first filled. Therefore, infections occurring after filling a TE cannot be attributed to CDC/NHSN-defined SSIs. We developed a standardized surveillance definition modified from the CDC definition that allows us to continue infection surveillance post-fill, up to 90-days post-operatively. We assessed cases captured by these two definitions.
METHODS: We reviewed charts of patients with TE placement from April 2016-June 2017 who met the criteria for our definition or the CDC definition for SSI. Demographic and clinical characteristics were abstracted.
RESULTS: We identified 183 patients. Twenty-seven (14.8%) patients experienced TE infections: 4 (14.8%) according to the CDC definition; 23 (85.2%) according to our definition (Figure 1). Eighteen (66.6%) patients returned to the OR for TE removal or replacement. Staphylococcus species were the most commonly identified organisms (Figure 2).
CONCLUSION: More than 85% of post-mastectomy TE infections were not captured by the CDC definition for SSI surveillance. This disparity demonstrates the need for a more global post-operative SSI surveillance window.
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