Keywords
Infectious Disease Specialists
trauma
surgery
trauma
surgery
How to Cite
Muco, E., Blloshmi, A., Jonuzi, E., & Dogjani, A. (2024). The Role of the Infectious Disease Specialists in the Trauma Surgical Team. Albanian Journal of Trauma and Emergency Surgery, 8(2), 1520-1524. https://doi.org/10.32391/ajtes.v8i2.401
Abstract
Introduction: Infection is a significant cause of posttraumatic morbidity and prolonged hospitalization. Nosocomial infections are a frequent complication of trauma patients admitted to the intensive care unit (ICU). Trauma is predisposed to infections by various mechanisms, while intravascular catheters, endotracheal tubes, and urinary catheters create suitable environments for nosocomial infection during treatment. Following trauma, wound contamination with aerobic and anaerobic bacteria should always be suspected.
Material and Methods: In this paper, we want to review the literature regarding the role of infectious disease (ID) specialists in the trauma team and compare it with the situation in our country.
Discussion: Infections in trauma are developed because of endogenous bacteremia or as a result of exogenous bacteremia. Since infection significantly prolongs the hospitalization of trauma patients, the infection disease specialist plays a crucial role in preventing and treating infections in collaboration with the surgeon and other trauma team members.
The duration of antibiotic treatment is significant. A shorter duration will result in fewer side effects and allergic reactions and reduce long-term antibiotic resistance.
Conclusions: The infectious disease specialist is not a standalone figure but an integral part of the trauma team. Their role is not limited to implementing protocols and using appropriate antibiotics before, during, and after surgical procedures. They also closely follow the patients, identifying those with a greater predisposition to develop infections. This collaborative approach is crucial for successfully preventing and managing infections in trauma patients.
References
1. Ehlenbach, W. J., & Curtis, J. R. (2008). Noninvasive ventilation for patients near the end of life: What do we know and what do we need to know? Critical care medicine, 36(3), 1003–1004. https://doi.org/10.1097/CCM.0B013E318165FD78
2. Guggenbichler, J. P., Assadian, O., Boeswald, M., & Kramer, A. (2011). Incidence and clinical implication of nosocomial infections associated with implantable biomaterials - catheters, ventilator-associated pneumonia, urinary tract infections. GMS Krankenhaushygiene interdisziplinar, 6(1), Doc18. https://doi.org/10.3205/dgkh000175
3. Digiovine, B., Chenoweth, C., Watts, C., & Higgins, M. (1999). The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. American journal of respiratory and critical care medicine, 160(3), 976–981. https://doi.org/10.1164/ajrccm.160.3.9808145
4. Zahn, M., Adalja, A. A., Auwaerter, P. G., Edelson, P. J., Hansen, G. R., Hynes, N. A., Jezek, A., MacArthur, R. D., Manabe, Y. C., McGoodwin, C., & Duchin, J. S. (2019). Infectious Diseases Physicians: Improving and Protecting the Public's Health: Why Equitable Compensation Is Critical. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 69(2), 352–356. https://doi.org/10.1093/cid/ciy888
5. Kassam, F., Cheong, A. R., Evans, D., & Singhal, A. (2019). What attributes define excellence in a trauma team? A qualitative study. Canadian journal of surgery. Journal canadien de chirurgie, 62(6), 450–453. https://doi.org/10.1503/cjs.013418
6. Sartelli, M., Malangoni, M. A., May, A. K., Viale, P., Kao, L. S., Catena, F., Ansaloni, L., Moore, E. E., Moore, F. A., Peitzman, A. B., Coimbra, R., Leppaniemi, A., Kluger, Y., Biffl, W., Koike, K., Girardis, M., Ordonez, C. A., Tavola, M., Cainzos, M., Di Saverio, S., … Yuan, K. C. (2014). World Society of Emergency Surgery (WSES) guidelines for management of skin and soft tissue infections. World journal of emergency surgery: WJES, 9(1), 57. https://doi.org/10.1186/1749-7922-9-57
7. Hitchcock C. R. (1987). Overwhelming infections in trauma. Postgraduate Medicine, 82(6), 77–85. https://doi.org/10.1080/00325481.1987.11700030
8. Lotfollahzadeh S, Burns B. Penetrating Abdominal Trauma. [Updated 2023 Jun 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459123/
9. Fullen, W. D., Hunt, J., & Altemeier, W. A. (1972). Prophylactic antibiotics in penetrating wounds of the abdomen. The Journal of Trauma, 12(4), 282–289. https://doi.org/10.1097/00005373-197204000-00003
10. Hietbrink, F., Koenderman, L., Rijkers, G., & Leenen, L. (2006). Trauma: the role of the innate immune system. World journal of emergency surgery: WJES, 1, 15. https://doi.org/10.1186/1749-7922-1-15
11. Lee, H. J., Choi, E., Choi, N. J., Sun, H. W., Lee, J. S., Lee, J. W., Kim, T. Y., Jung, Y. J., & Hong, S. K. (2020). Risk Factors of Bacteremia Following Multiple Traumas. Emergency Medicine International, 2020, 9217949. https://doi.org/10.1155/2020/9217949
12. Wallace, C. (1916). A study of 1200 cases of gunshot wounds of the abdomen. Br J Surg, 4: pp. 679–743. https://doi.org/10.1002/bjs.1800041608
13. Antonelli, M., Moro, M. L., D'Errico, R. R., Conti, G., Bufi, M., & Gasparetto, A. (1996). Early and late-onset bacteremia have different risk factors in trauma patients. Intensive care medicine, 22(8), 735–741. https://doi.org/10.1007/BF01709514
14. Sartelli, M., Coccolini, F., Kluger, Y. et al. WSES/GAIS/WSIS/SIS-E/AAST global clinical pathways for patients with skin and soft tissue infections. World J Emerg Surg 17, 3 (2022). https://doi.org/10.1186/s13017-022-00406-2
15. Fabian, T. C., Croce, M. A., Payne, L. W., Minard, G., Pritchard, F. E., & Kudsk, K. A. (1992). Duration of antibiotic therapy for penetrating abdominal trauma: a prospective trial. Surgery, 112(4), 788–795. PMID: 1411952
16. Huang M, Cai S, Su J. The Pathogenesis of Sepsis and Potential Therapeutic Targets. International Journal of Molecular Sciences. 2019; 20(21):5376. https://doi.org/10.3390/ijms20215376
17. Stoutenbeek, C. P., van Saene, H. K., Miranda, D. R., & Zandstra, D. F. (1984). The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients. Intensive care medicine, 10(4), 185–192. https://doi.org/10.1007/BF00259435
18. Baseel, D., Kim, J., Mohammed, S., Lowe, A., & Siddiqi, J. (2022). The Ideal Time to Administer Pre-operative Antibiotics: Current and Future Practices. Cureus, 14(5), e24979. https://doi.org/10.7759/cureus.24979
19. Brand, M., Goosen, J., & Grieve, A. (2009). Prophylactic antibiotics for penetrating abdominal trauma. The Cochrane database of systematic reviews, (4), CD007370. https://doi.org/10.1002/14651858.CD007370.pub2
20. Nelson, R. L., Gladman, E., & Barbateskovic, M. (2014). Antimicrobial prophylaxis for colorectal surgery. The Cochrane database of systematic reviews, 2014(5), CD001181. https://doi.org/10.1002/14651858.CD001181.pub4
21. Costa, A. C. D., Santa-Cruz, F., & Ferraz, Á. A. B. (2021). WHAT'S NEW IN INFECTION ON SURGICAL SITE AND ANTIBIOTIC PROPHYLAXIS IN SURGERY? Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery, 33(4), e1558. https://doi.org/10.1590/0102-672020200004e1558
22. Fowler, J. W. (1982). Stages of faith: The psychology of human development and the quest for meaning. Harper & Row.
23. Sartelli, M., Coccolini, F., Abu-Zidan, F.M. et al. Hey surgeons! It is time to lead and be a champion in preventing and managing surgical infections! World J Emerg Surg 15, 28 (2020). https://doi.org/10.1186/s13017-020-00308-1
24. Sartelli, M., Kluger, Y., Ansaloni, L., et al. Global Alliance for Infections in Surgery Working Group- A Global Declaration on Appropriate Use of Antimicrobial Agents across the Surgical Pathway. (2017). Surgical infections, 18(8), 846–853. https://doi.org/10.1089/sur.2017.219
25. Bryan C. S. (1996). Fever, famine, and war: William Osler as an infectious diseases specialist. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 23(5), 1139–1149. https://doi.org/10.1093/clinids/23.5.1139
26. Sartelli, M., Boermeester, M. A., Cainzos, M., Coccolini, F., de Jonge, S. W., Rasa, K., Dellinger, E. P., McNamara, D. A., Fry, D. E., Cui, Y., Delibegovic, S., Demetrashvili, Z., De Simone, B., Gkiokas, G., Hardcastle, T. C., Itani, K. M. F., Isik, A., Labricciosa, F. M., Lohsiriwat, V., Marwah, S., … Barie, P. S. (2023). Six Long-Standing Questions about Antibiotic Prophylaxis in Surgery. Antibiotics (Basel, Switzerland), 12(5), 908. https://doi.org/10.3390/antibiotics12050908
27. Ulasi, I. B., Aigbovo, E. O., Michael, A. I., Ayandipo, O. O., Fowotade, A., Ishiyaka, U. M., Ezeme, C., Olagunju, N. A., & Ikwu, C. K. (2023). THE EFFECT OF SKIN ANTISEPSIS AFTER PRIMARY SKIN CLOSURE ON THE INCIDENCE OF SURGICAL SITE INFECTION AFTER ABDOMINAL SURGERY FOR SEPSIS: A PRELIMINARY REPORT OF A RANDOMISED CONTROLLED TRIAL. Annals of Ibadan postgraduate medicine, 21(3), 46–56.
28. Upadhyyaya, G. K., & Tewari, S. (2023). Enhancing Surgical Outcomes: A Critical Review of Antibiotic Prophylaxis in Orthopedic Surgery. Cureus, 15(10), e47828. https://doi.org/10.7759/cureus.47828
29. Hoentjen, F., Harmsen, H. J., Braat, H., Torrice, C. D., Mann, B. A., Sartor, R. B., & Dieleman, L. A. (2003). Antibiotics with a selective aerobic or anaerobic spectrum have different therapeutic activities in various colon regions in interleukin 10 gene deficient mice. Gut, 52(12), 1721–1727. https://doi.org/10.1136/gut.52.12.1721
30. Walter, E. J., Hanna-Jumma, S., Carraretto, M., & Forni, L. (2016). The pathophysiological basis and consequences of fever. Critical care (London, England), 20(1), 200. https://doi.org/10.1186/s13054-016-1375-5
31. Frank, M. O., Batteiger, B. E., Sorensen, S. J., Hartstein, A. I., Carr, J. A., McComb, J. S., Clark, C. D., Abel, S. R., Mikuta, J. M., & Jones, R. B. (1997). Decrease in expenditures and selected nosocomial infections following implementation of an antimicrobial-prescribing improvement program. Clinical performance and quality health care, 5(4), 180–188.
32. Gorecki, P. J., Schein, M., Mehta, V., & Wise, L. (2000). Surgeons and infectious disease specialists: different attitudes towards antibiotic treatment and prophylaxis in common abdominal surgical infections. Surgical infections, 1(2), 115–126. https://doi.org/10.1089/109629600321155
33. Osborn, T. M., Tracy, J. K., Dunne, J. R., Pasquale, M., & Napolitano, L. M. (2004). Epidemiology of sepsis in patients with traumatic injury. Critical care medicine, 32(11), 2234–2240. https://doi.org/10.1097/01.ccm.0000145586.23276.0f
34. Thadepalli, H., Gorbach, S. L., Broido, P. W., Norsen, J., & Nyhus, L. (1973). Abdominal trauma, anaerobes, and antibiotics. Surgery, gynecology & obstetrics, 137(2), 270–276.
35. Noakes, T. D., Borresen, J., Hew-Butler, T., Lambert, M. I., & Jordaan, E. (2008). Semmelweis and the etiology of puerperal sepsis 160 years on a historical review. Epidemiology and infection, 136(1), 1–9. https://doi.org/10.1017/S0950268807008746
36. Stang, A., Standl, F., & Poole, C. (2022). A twenty-first-century perspective on concepts of modern epidemiology in Ignaz Philipp Semmelweis' work on puerperal sepsis. European journal of epidemiology, 37(5), 437–445. https://doi.org/10.1007/s10654-022-00871-8
2. Guggenbichler, J. P., Assadian, O., Boeswald, M., & Kramer, A. (2011). Incidence and clinical implication of nosocomial infections associated with implantable biomaterials - catheters, ventilator-associated pneumonia, urinary tract infections. GMS Krankenhaushygiene interdisziplinar, 6(1), Doc18. https://doi.org/10.3205/dgkh000175
3. Digiovine, B., Chenoweth, C., Watts, C., & Higgins, M. (1999). The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. American journal of respiratory and critical care medicine, 160(3), 976–981. https://doi.org/10.1164/ajrccm.160.3.9808145
4. Zahn, M., Adalja, A. A., Auwaerter, P. G., Edelson, P. J., Hansen, G. R., Hynes, N. A., Jezek, A., MacArthur, R. D., Manabe, Y. C., McGoodwin, C., & Duchin, J. S. (2019). Infectious Diseases Physicians: Improving and Protecting the Public's Health: Why Equitable Compensation Is Critical. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 69(2), 352–356. https://doi.org/10.1093/cid/ciy888
5. Kassam, F., Cheong, A. R., Evans, D., & Singhal, A. (2019). What attributes define excellence in a trauma team? A qualitative study. Canadian journal of surgery. Journal canadien de chirurgie, 62(6), 450–453. https://doi.org/10.1503/cjs.013418
6. Sartelli, M., Malangoni, M. A., May, A. K., Viale, P., Kao, L. S., Catena, F., Ansaloni, L., Moore, E. E., Moore, F. A., Peitzman, A. B., Coimbra, R., Leppaniemi, A., Kluger, Y., Biffl, W., Koike, K., Girardis, M., Ordonez, C. A., Tavola, M., Cainzos, M., Di Saverio, S., … Yuan, K. C. (2014). World Society of Emergency Surgery (WSES) guidelines for management of skin and soft tissue infections. World journal of emergency surgery: WJES, 9(1), 57. https://doi.org/10.1186/1749-7922-9-57
7. Hitchcock C. R. (1987). Overwhelming infections in trauma. Postgraduate Medicine, 82(6), 77–85. https://doi.org/10.1080/00325481.1987.11700030
8. Lotfollahzadeh S, Burns B. Penetrating Abdominal Trauma. [Updated 2023 Jun 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459123/
9. Fullen, W. D., Hunt, J., & Altemeier, W. A. (1972). Prophylactic antibiotics in penetrating wounds of the abdomen. The Journal of Trauma, 12(4), 282–289. https://doi.org/10.1097/00005373-197204000-00003
10. Hietbrink, F., Koenderman, L., Rijkers, G., & Leenen, L. (2006). Trauma: the role of the innate immune system. World journal of emergency surgery: WJES, 1, 15. https://doi.org/10.1186/1749-7922-1-15
11. Lee, H. J., Choi, E., Choi, N. J., Sun, H. W., Lee, J. S., Lee, J. W., Kim, T. Y., Jung, Y. J., & Hong, S. K. (2020). Risk Factors of Bacteremia Following Multiple Traumas. Emergency Medicine International, 2020, 9217949. https://doi.org/10.1155/2020/9217949
12. Wallace, C. (1916). A study of 1200 cases of gunshot wounds of the abdomen. Br J Surg, 4: pp. 679–743. https://doi.org/10.1002/bjs.1800041608
13. Antonelli, M., Moro, M. L., D'Errico, R. R., Conti, G., Bufi, M., & Gasparetto, A. (1996). Early and late-onset bacteremia have different risk factors in trauma patients. Intensive care medicine, 22(8), 735–741. https://doi.org/10.1007/BF01709514
14. Sartelli, M., Coccolini, F., Kluger, Y. et al. WSES/GAIS/WSIS/SIS-E/AAST global clinical pathways for patients with skin and soft tissue infections. World J Emerg Surg 17, 3 (2022). https://doi.org/10.1186/s13017-022-00406-2
15. Fabian, T. C., Croce, M. A., Payne, L. W., Minard, G., Pritchard, F. E., & Kudsk, K. A. (1992). Duration of antibiotic therapy for penetrating abdominal trauma: a prospective trial. Surgery, 112(4), 788–795. PMID: 1411952
16. Huang M, Cai S, Su J. The Pathogenesis of Sepsis and Potential Therapeutic Targets. International Journal of Molecular Sciences. 2019; 20(21):5376. https://doi.org/10.3390/ijms20215376
17. Stoutenbeek, C. P., van Saene, H. K., Miranda, D. R., & Zandstra, D. F. (1984). The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients. Intensive care medicine, 10(4), 185–192. https://doi.org/10.1007/BF00259435
18. Baseel, D., Kim, J., Mohammed, S., Lowe, A., & Siddiqi, J. (2022). The Ideal Time to Administer Pre-operative Antibiotics: Current and Future Practices. Cureus, 14(5), e24979. https://doi.org/10.7759/cureus.24979
19. Brand, M., Goosen, J., & Grieve, A. (2009). Prophylactic antibiotics for penetrating abdominal trauma. The Cochrane database of systematic reviews, (4), CD007370. https://doi.org/10.1002/14651858.CD007370.pub2
20. Nelson, R. L., Gladman, E., & Barbateskovic, M. (2014). Antimicrobial prophylaxis for colorectal surgery. The Cochrane database of systematic reviews, 2014(5), CD001181. https://doi.org/10.1002/14651858.CD001181.pub4
21. Costa, A. C. D., Santa-Cruz, F., & Ferraz, Á. A. B. (2021). WHAT'S NEW IN INFECTION ON SURGICAL SITE AND ANTIBIOTIC PROPHYLAXIS IN SURGERY? Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery, 33(4), e1558. https://doi.org/10.1590/0102-672020200004e1558
22. Fowler, J. W. (1982). Stages of faith: The psychology of human development and the quest for meaning. Harper & Row.
23. Sartelli, M., Coccolini, F., Abu-Zidan, F.M. et al. Hey surgeons! It is time to lead and be a champion in preventing and managing surgical infections! World J Emerg Surg 15, 28 (2020). https://doi.org/10.1186/s13017-020-00308-1
24. Sartelli, M., Kluger, Y., Ansaloni, L., et al. Global Alliance for Infections in Surgery Working Group- A Global Declaration on Appropriate Use of Antimicrobial Agents across the Surgical Pathway. (2017). Surgical infections, 18(8), 846–853. https://doi.org/10.1089/sur.2017.219
25. Bryan C. S. (1996). Fever, famine, and war: William Osler as an infectious diseases specialist. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 23(5), 1139–1149. https://doi.org/10.1093/clinids/23.5.1139
26. Sartelli, M., Boermeester, M. A., Cainzos, M., Coccolini, F., de Jonge, S. W., Rasa, K., Dellinger, E. P., McNamara, D. A., Fry, D. E., Cui, Y., Delibegovic, S., Demetrashvili, Z., De Simone, B., Gkiokas, G., Hardcastle, T. C., Itani, K. M. F., Isik, A., Labricciosa, F. M., Lohsiriwat, V., Marwah, S., … Barie, P. S. (2023). Six Long-Standing Questions about Antibiotic Prophylaxis in Surgery. Antibiotics (Basel, Switzerland), 12(5), 908. https://doi.org/10.3390/antibiotics12050908
27. Ulasi, I. B., Aigbovo, E. O., Michael, A. I., Ayandipo, O. O., Fowotade, A., Ishiyaka, U. M., Ezeme, C., Olagunju, N. A., & Ikwu, C. K. (2023). THE EFFECT OF SKIN ANTISEPSIS AFTER PRIMARY SKIN CLOSURE ON THE INCIDENCE OF SURGICAL SITE INFECTION AFTER ABDOMINAL SURGERY FOR SEPSIS: A PRELIMINARY REPORT OF A RANDOMISED CONTROLLED TRIAL. Annals of Ibadan postgraduate medicine, 21(3), 46–56.
28. Upadhyyaya, G. K., & Tewari, S. (2023). Enhancing Surgical Outcomes: A Critical Review of Antibiotic Prophylaxis in Orthopedic Surgery. Cureus, 15(10), e47828. https://doi.org/10.7759/cureus.47828
29. Hoentjen, F., Harmsen, H. J., Braat, H., Torrice, C. D., Mann, B. A., Sartor, R. B., & Dieleman, L. A. (2003). Antibiotics with a selective aerobic or anaerobic spectrum have different therapeutic activities in various colon regions in interleukin 10 gene deficient mice. Gut, 52(12), 1721–1727. https://doi.org/10.1136/gut.52.12.1721
30. Walter, E. J., Hanna-Jumma, S., Carraretto, M., & Forni, L. (2016). The pathophysiological basis and consequences of fever. Critical care (London, England), 20(1), 200. https://doi.org/10.1186/s13054-016-1375-5
31. Frank, M. O., Batteiger, B. E., Sorensen, S. J., Hartstein, A. I., Carr, J. A., McComb, J. S., Clark, C. D., Abel, S. R., Mikuta, J. M., & Jones, R. B. (1997). Decrease in expenditures and selected nosocomial infections following implementation of an antimicrobial-prescribing improvement program. Clinical performance and quality health care, 5(4), 180–188.
32. Gorecki, P. J., Schein, M., Mehta, V., & Wise, L. (2000). Surgeons and infectious disease specialists: different attitudes towards antibiotic treatment and prophylaxis in common abdominal surgical infections. Surgical infections, 1(2), 115–126. https://doi.org/10.1089/109629600321155
33. Osborn, T. M., Tracy, J. K., Dunne, J. R., Pasquale, M., & Napolitano, L. M. (2004). Epidemiology of sepsis in patients with traumatic injury. Critical care medicine, 32(11), 2234–2240. https://doi.org/10.1097/01.ccm.0000145586.23276.0f
34. Thadepalli, H., Gorbach, S. L., Broido, P. W., Norsen, J., & Nyhus, L. (1973). Abdominal trauma, anaerobes, and antibiotics. Surgery, gynecology & obstetrics, 137(2), 270–276.
35. Noakes, T. D., Borresen, J., Hew-Butler, T., Lambert, M. I., & Jordaan, E. (2008). Semmelweis and the etiology of puerperal sepsis 160 years on a historical review. Epidemiology and infection, 136(1), 1–9. https://doi.org/10.1017/S0950268807008746
36. Stang, A., Standl, F., & Poole, C. (2022). A twenty-first-century perspective on concepts of modern epidemiology in Ignaz Philipp Semmelweis' work on puerperal sepsis. European journal of epidemiology, 37(5), 437–445. https://doi.org/10.1007/s10654-022-00871-8
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