World Journal of Surgical Infection

EDITORIAL
Year
: 2022  |  Volume : 1  |  Issue : 1  |  Page : 1--2

Combating surgical infections


Jianan Ren 
 Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 21002, P.R. of China

Correspondence Address:
Jianan Ren
MD, FACS, Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 21002
P.R. of China




How to cite this article:
Ren J. Combating surgical infections.World J Surg Infect 2022;1:1-2


How to cite this URL:
Ren J. Combating surgical infections. World J Surg Infect [serial online] 2022 [cited 2022 Dec 9 ];1:1-2
Available from: https://www.worldsurginfect.com/text.asp?2022/1/1/1/347771


Full Text



Surgeons are facing a wide range of surgical infections acquired in communities or health-care facilities in their daily clinical practice. These surgical infections could be surgical site infections, intra-abdominal infections, respiratory infections, urinary tract infections, soft-tissue infections, and even gut-derived infections.

The pathogen in surgical infections can be bacterial, viral, and fungal. Once happened, surgical infection will be a huge burden both for the patients and the healthcare system. Poor control of the surgical infections will lead to the progression toward sepsis and septic shock, which exponentially increase mortality rates.

Throughout the scientific activities of the World Surgical Infection Society (WSIS), we firmly believe the importance of a journal that will summarize the management strategies and treatment advancements in each country to combat surgical infections. Since 2014, we have worked together under the leadership of World Health Organization (WHO) in the making and implementation of Global Guidelines for the Prevention of Surgical Site Infections.[1],[2] For a wider discussion and attention of surgeons on surgical infections, we further decided to launch a globally impactful journal and started to make a detailed plan including finding an appropriate publisher and funds.

The program to put together a journal focusing on surgical infections was disrupted by the COVID-19 pandemic, but the actions never stopped. Today, with our collective efforts, the dream has finally come to fruition. The WSIS finally has its own official journal, i.e., the World Journal of Surgical Infection.

It is our hope that this journal will serve as our outlet in sharing knowledge and experiences in surgical infection management. The type of articles delivered by our journal will also be diverse including original research, literature review, case series, letters, expert opinions, conference highlights, and much more. We hope this journal will serve as a platform for health-care professionals to exchange ideas and research findings about surgical infections in all fields of medicine and surgery, and sometimes the interdisciplinary areas incorporated with modern technologies such as intelligent monitoring of wounds. We believe these peer-reviewed and open access papers will help surgeons to keep up to date with the current methodologies and guide them in formulating clinical treatment strategies and making decisions.

There are a lot of progress in surgical infection diagnosis strategies, source control techniques, and medical managements in the past 20 years. We are happy to share all the progress in these fields and build discussion around these topics.

Prevention strategies are crucial in reducing the onset of surgical site infections. Countries around the world and the WHO have already built their own prevention guidelines through based evidence. However, promoting and implementing these preventive strategies are very challenging. We hope the World Journal of Surgical Infection will be able to carry out this task.

The source control measures are another important work for surgeons. The damage control strategy has deeply impacted the decision-making and all kind of invasive procedures. There are a wide variety of innovative source control strategies including open abdominal therapy in the case of severe intra-abdominal infection, as well as ultrasound or CT-guided percutaneous abscess drainage. Understanding the fundamentals of inflammatory responses and the pathophysiology behind multi-organ dysfunctions caused by surgical infection will be crucial for surgeons to evaluate the effect of surgical intervention, the necessity, and timing of re-intervention of each surgical infection case.

Nosocomial pneumonia is the most common pulmonary-infected complication after surgeries. In recent years, chronic critically illness and persistent critically illness became the epidemic in the surgical ICU mainly because of increased rates of nosocomial surgical infections, partly due to improvements in our abilities in managing critically ill patients.[3],[4] Nosocomial pneumonia is currently the most common surgical infection in the surgical ICU. Respiration therapy and respiratory therapists is an effective solution to this challenge and deserves further promotion, especially in the clinical practice dominated by operations.

Other surgical infections include catheter-related infections, skin, and soft-tissue infections as well as gut-derived infections. These are all serious surgical infections that deserve special attentions and investigations.

Advance in molecular genetic research has provided us with powerful diagnostic arsenals in bacterial resistance for precision-based diagnosis.[5],[6] These research advancements have also helped us to understand the molecular mechanisms behind multidrug-resistant (MDR) and pandrug-resistant (PDR) bacteria, as well as conducting microbial traceability work.

Antibiotics are the most effective medications in treating systematic surgical infection. However, with every new generation of antibiotic comes with new drug-resistant bacteria.[7] Understanding the pharmacological basics of antibiotics such as pharmacokinetic/pharmacodynamic (PK/PD) and minimum effective concentration even in the patients with continuous renal replacement therapy (CRRT) will be crucial for us to devise the most appropriate therapy including combinational of two or three antibiotics for the MDR and PDR bacteria.[8],[9]

Surviving sepsis campaign changed our understandings of sepsis and revolutionized the management of critically ill patients with surgical infection.[10] The shift of attention from traditional bacteremia and toxemia to sepsis and septic shock improved the current clinical management approach and save the patients with multi-organ dysfunction. For the critically illness with surgical infection, priority should be focused on resuscitations and preserving organ functions through an arsenal of interventions such as ventilator, CRRT, and extracorporeal membrane oxygenation beside the in time and appropriate source control measures.

While the current surgical practice climate focuses on minimizing procedure invasiveness, surgeons should also work on understanding the fundamentals of surgical infection treatment methodologies. It is important for us to treat surgical infection through a multidimensional approach such as genetics and radiological in adjunct to surgical interventions. These methods can be further adjusted in different countries and different health-care settings. It is certain that we may have different successful personal opinions and experience. World Journal of Surgical Infection will publish these results and benefit both surgeons and patients. We may have different belief and cultural backgrounds, but we all share a common goal, which is to “survive surgical infections.” This is why we are here building this World Journal of Surgical Infection.

There is a long way to go in the field of surgical infections, with much more questions left unanswered. Let us work together to share our experience and lessons learned in combating surgical infections.

References

1Allegranzi B, Bischoff P, de Jonge S, Kubilay NZ, Zayed B, Gomes SM, et al. New WHO recommendations on preoperative measures for surgical site infection prevention: An evidence-based global perspective. Lancet Infect Dis 2016;16:e276-87.
2Allegranzi B, Zayed B, Bischoff P, Kubilay NZ, de Jonge S, de Vries F, et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: An evidence-based global perspective. Lancet Infect Dis 2016;16:e288-303.
3Jeffcote T, Foong M, Gold G, Glassford N, Robbins R, Iwashyna TJ, et al. Patient characteristics, ICU-specific supports, complications, and outcomes of persistent critical illness. J Crit Care 2019;54:250-5.
4Lamas D. Chronic critical illness. N Engl J Med 2014;370:175-7.
5Welch NL, Zhu M, Hua C, Weller J, Mirhashemi ME, Nguyen TG, et al. Multiplexed CRISPR-based microfluidic platform for clinical testing of respiratory viruses and identification of SARS-CoV-2 variants. Nat Med 2022. doi: 10.1038/s41591-022-01734-1.
6Li N, Cai Q, Miao Q, Song Z, Fang Y, Hu B. High-throughput metagenomics for identification of pathogens in the clinical settings. Small Methods 2021;5:2000792.
7Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. Lancet 2022;399:629-55.
8Tamma PD, Aitken SL, Bonomo RA, Mathers AJ, van Duin D, Clancy CJ. Infectious Diseases Society of America Guidance on the Treatment of Extended-Spectrum β-lactamase Producing Enterobacterales (ESBL-E), Carbapenem-Resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with Difficult-to-Treat Resistance (DTR-P. aeruginosa). Clin Infect Dis 2021;72:e169-83.
9Paul M, Carrara E, Retamar P, Tängdén T, Bitterman R, Bonomo RA, et al. European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines for the treatment of infections caused by multidrug-resistant Gram-negative bacilli (endorsed by European Society of Intensive Care Medicine). Clin Microbiol Infect 2022;28:521-47.
10Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004;32:858-73.