Surgical Site Infections by OXA-48 Carbapenemase-Producing Enterobacteriaceae

To the Editor:

We have read with great interest the article published by El-Kholy et al. regarding surgical site infections (SSI) after emergency surgery related to gram-negative pathogens [1]. They detailed carbapenem-resistant bacteria causing 61% of the SSI that appeared after abdominal surgery, with VIM, KPC, and NDM being the most common resistance genes. Infections with carbapenemase-producing Enterobacteriaceae (CPE) are a significant problem in public health at present, and research studies specifically investigating patients with intra-abdominal infections or surgical populations (SSI and other types) are scarce [2].

We recently published our experience with CPE-related SSI in patients having abdominal surgery [3]. We included 50 patients, of whom 20 underwent a previous emergency operation. In our series, the presence of organ/space SSI (70%) and OXA-48-CPE (98%) was especially relevant. The prevalence of OXA-48-producing strains is a finding previously detailed in studies with CPE from Spanish hospitals [4], and it differs from the study by El-Kholy et al., because it comes from a different geographic area. Analyzing the underlying disease, in our study, colorectal (40%) and pancreatic (20%) sites were the most frequent, similar to findings of a previous study with K. pneumoniae KPC infections in patients with abdominal surgery in an intensive care setting [2].

We want to underline the relevance of CPE-related SSI through a population with OXA-48 carbapenemase from a Spanish hospital. Our patients suffered a mortality rate of 20% from organ/space SSI, a prolonged stay (median 45 days), and elevated cost (almost 30,000€ per admission). The economic and social costs are relevant issues known worldwide, and the global economic value of a CPE infection for society has been estimated at US$37,000–$83,000 [5].

In summary, CPE infections are a serious problem for society today, and also for surgical patients. The modern surgeon must be aware of the possibility of drug resistance, with all the associated consequences. Thus, compliance with the optimal measures for SSI prevention is important, but also the judicious prescription of antibiotics.