Cerrahi Alan Enfeksiyonlarının Önlenmesinde Yeni Yaklaşımlar: Güncel Literatürün Gözden Geçirilmesi

Öz

Cerrahi alan enfeksiyonları (CAE), modern cerrahi uygulamalardaki gelişmelere rağmen morbidite ve mortaliteyi artıran, hastanede kalış süresini uzatan ve sağlık maliyetlerini yükselten yaygın sağlık hizmetleriyle ilişkili enfeksiyonlar arasında yer almaktadır. Günümüzde CAE’nin önlenmesi, standart antiseptik önlemlerin ötesinde, hasta riski ve cerrahi özelliklere göre şekillenen çok bileşenli ve kişiselleştirilmiş stratejilere yönelmektedir. Bu çalışmada, CAE’nin önlenmesine yönelik güncel yaklaşımlar preoperatif, intraoperatif ve postoperatif dönemler açısından değerlendirilmiştir. Literatür taraması PubMed/MEDLINE, Scopus, Web of Science ve Google Scholar veri tabanlarında gerçekleştirilmiş; özellikle 2020–2026 yılları arasında yayımlanan çalışmalar incelenmiştir. Nazal dekolonizasyon, klorheksidin bazlı antiseptik hazırlık, triklosan kaplı sütürler, çift halka yapılı yara koruyucular, kapalı insizyon negatif basınçlı yara tedavisi (ciNPWT), perioperatif normotermi ve oksijenizasyon stratejileri ile dijital yara izlemi ve yapay zekâ destekli sürveyans sistemleri değerlendirilmiştir. Güncel veriler, özellikle yüksek riskli hasta gruplarında triklosan kaplı sütürler ve ciNPWT gibi yöntemlerin CAE oranlarını azaltabileceğini göstermektedir. Bununla birlikte, bazı yeni teknolojiler için kanıt düzeyi sınırlıdır ve sonuçlar cerrahi branşlara göre değişkenlik gösterebilmektedir. Ayrıca, antimikrobiyal direnç ve antimikrobiyal yönetim uygulamaları, enfeksiyon kontrolünün temel bileşenleri arasında yer almaktadır. Sonuç olarak, CAE oranlarının azaltılmasında kanıta dayalı standartların uygulanması, multidisipliner yaklaşımın benimsenmesi ve risk temelli kişiselleştirilmiş stratejilerin kullanılması büyük önem taşımaktadır.

Anahtar Kelimeler

• Cerrahi alan enfeksiyonu
• triklosan kaplı sütürler
• negatif basınçlı yara tedavisi
• antimikrobiyal yönetim

New Approaches to the Prevention of Surgical Site Infections: A Review of the Current Literature

Öz

Surgical site infections (SSIs) remain a common healthcare-associated infections, increasing morbidity and mortality, prolonging hospital stays, and raising healthcare costs, despite advances in modern surgical practices. Contemporary SSI prevention strategies have evolved beyond standard antiseptic measures toward multifactorial and personalized approaches based on patient risk profiles and surgical characteristics. In this study evaluated current approaches for SSI prevention during the preoperative, intraoperative, and postoperative periods. A literature search was conducted using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar databases, primarily focusing on studies published between 2020 and 2026. Current preventive strategies, including nasal decolonization, chlorhexidine-based antiseptic preparation, triclosan-coated sutures, dual-ring wound protectors, closed incision negative pressure wound therapy (ciNPWT), perioperative normothermia and oxygenation strategies, digital wound monitoring, and artificial intelligence-assisted surveillance systems, were reviewed. Recent evidence suggests that interventions such as triclosan-coated sutures and ciNPWT may reduce SSI rates, particularly in high-risk patient populations. However, evidence remains limited for several emerging technologies, and outcomes may vary among surgical specialties. In addition, antimicrobial resistance and antibiotic stewardship programs have become essential components of infection prevention strategies. In conclusion, effective SSI prevention requires evidence-based perioperative standards, multidisciplinary collaboration, and risk-based personalized approaches rather than a universal strategy.

Anahtar Kelimeler

• Surgical site infection
• triclosan-coated sutures
• negative pressure wound therapy
• antimicrobial stewardship

Kaynakça

1. 1. Centers for Disease Control and Prevention. National Healthcare Safety Network (NHSN) surveillance definitions for specific types of infections. Atlanta: CDC; 2025.
2. 2. Reichman DE, Greenberg JA. Reducing surgical site infections: a review. Rev Obstet Gynecol. 2009;2(4):212-21.
3. 3. Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784-91.
4. 4. Seidelman JL, Mantyh CR, Anderson DJ. Surgical site infection prevention: a review. JAMA. 2023;329(3):244-52.
5. 5. Mengistu DA, Alemu A, Abdukadir AA, et al. Global incidence of surgical site infection among patients: systematic review and meta-analysis. Inquiry. 2023;60:469580231162549.
6. 6. Worku S, Abebe T, Alemu A, et al. Bacterial profile of surgical site infection and antimicrobial resistance patterns in Ethiopia: a multicentre prospective cross-sectional study. Ann Clin Microbiol Antimicrob. 2023;22(1):96.
7. 7. Zimlichman E, Henderson D, Tamir O, Franz C, Song P, Yamin CK, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med. 2013;173(22):2039-46.
8. 8. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection. J Hosp Infect. 2014;86(1):24-33.

9. 9. Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect. 2008;70 Suppl 2:3-10.
10. 10. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999;20(4):250-78.
11. 11. World Health Organization. Global guidelines for the prevention of surgical site infection. 2nd ed. Geneva: WHO; 2018.
12. 12. McLean KA, Mountain DA, Shaw CA, Drake TM, Pius R, Harrison EM, et al. Remote diagnosis of surgical-site infection using a smartphone-based wound assessment tool: a diagnostic study. NPJ Digit Med. 2021;4:125.
13. 13. Lathan R, Blanquicett C, et al. Diagnostic accuracy of telemedicine for detection of surgical site infection: a systematic review and meta-analysis. NPJ Digit Med. 2022;5:100.
14. 14. Ontario Health (Quality). Pre-surgical nasal decolonization of Staphylococcus aureus: a health technology assessment. Ont Health Technol Assess Ser. 2022;22(4):1-165.
15. 15. Septimus EJ, Schweizer ML. Decolonization in prevention of health care-associated infections. Clin Microbiol Rev. 2016;29(2):201-22.
16. 16. Kalmeijer MD, Coertjens H, van Nieuwland-Bollen PM, et al. Surgical site infections in orthopedic surgery: the effect of mupirocin nasal ointment in a double-blind, randomized, placebo-controlled study. Clin Infect Dis. 2002;35(4):353-8.
17. 17. Smith H, Borchard K, Cherian P, Tai Y, Vinciullo C. Randomized controlled trial of preoperative topical decolonization to reduce surgical site infection for Staphylococcus aureus nasal swab-negative Mohs micrographic surgery patients. Dermatol Surg. 2019;45(2):229-33.
18. 18. Rohrer F, Nötzli H, Risch L, Bodmer T, Cottagnoud P, Hermann T, et al. Does preoperative decolonization reduce surgical site infections in elective orthopaedic surgery? A prospective randomized controlled trial. Clin Orthop Relat Res. 2020;478(8):1790-800.
19. 19. Chan AK, Ammanuel SG, Chan AY, et al. Chlorhexidine showers are associated with a reduction in surgical site infection following spine surgery: an analysis of 4266 consecutive surgeries. Neurosurgery. 2019;85(6):817-26.
20. 20. Ammanuel SG, Edwards CS, Chan AK, Mummaneni PV, Kidane J, Vargas E, et al. Are preoperative chlorhexidine gluconate showers associated with a reduction in surgical site infection following craniotomy? A retrospective cohort analysis of 3126 surgical procedures. J Neurosurg. 2021;135(6):1889-97.
21. 21. Gallouche M, Rubens-Duval B, Boisset S, Margotton M, Caspar Y, Le Maréchal M, et al. Evaluation of microbiological efficacy of 2% chlorhexidine gluconate cloths versus 4% chlorhexidine gluconate soap for preoperative preparation/shower in total joint arthroplasty: a single-centre randomised controlled trial. Antimicrob Resist Infect Control. 2025;14(1):143.
22. 22. Derosa L, Iebba V, Silva CAC, et al. Custom scoring based on ecological topology of gut microbiota associated with cancer immunotherapy outcome. Cell. 2024;187(13):3373-89.e16.
23. 23. Fonnes S, Mollerup S, Paulsen SJ, Holzknecht BJ, Westh H, Rosenberg J. The microbiome of the appendix differs in patients with and without appendicitis: a prospective cohort study. Surgery. 2024;175(6):1482-8.
24. 24. Rayes N, Hansen S, Seehofer D, et al. Early enteral supply of fiber and Lactobacilli versus conventional nutrition: a controlled trial in patients with major abdominal surgery. Nutrition. 2002;18(7-8):609-15.
25. 25. Sommacal HM, Bersch VP, Vitola SP, Osvaldt AB. Perioperative synbiotics decrease postoperative complications in periampullary neoplasms: a randomized, double-blind clinical trial. Nutr Cancer. 2015;67(3):457-62.
26. 26. Flesch AT, Tonial ST, Contu PC, Damin DC. Perioperative synbiotics decrease postoperative infectious complications in patients with colorectal cancer: a randomized, double-blind clinical trial. Rev Col Bras Cir. 2017;44(6):567-73.
27. 27. Kates AE, Zimbric ML, Mitchell K, Skarlupka J, Safdar N. The impact of chlorhexidine gluconate on the skin microbiota of children and adults: a pilot study. Am J Infect Control. 2019;47(8):1014-6.
28. 28. Henry-Stanley MJ, Hess DJ, Barnes AM, Dunny GM, Wells CL. Bacterial contamination of surgical suture resembles a biofilm. Surg Infect (Larchmt). 2010;11(5):433-9.
29. 29. Leaper D, Assadian O, Hubner NO, et al. Antimicrobial sutures and prevention of surgical site infection: assessment of the safety of the antiseptic triclosan. Int Wound J. 2011;8(6):556-66.
30. 30. Apisarnthanarak A, Singh N, Bandong AN, Madriaga G. Triclosan-coated sutures reduce the risk of surgical site infections: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2015;36(2):169-79.
31. 31. de Jonge SW, Atema JJ, Solomkin JS, Boermeester MA. Meta-analysis and trial sequential analysis of triclosan-coated sutures for the prevention of surgical-site infection. Br J Surg. 2017;104(2):e118-33.
32. 32. Ahmed I, Boulton AJ, Rizvi S, et al. The use of triclosan-coated sutures to prevent surgical site infections: a systematic review and meta-analysis of the literature. BMJ Open. 2019;9(9):e029727.
33. 33. Jalalzadeh H, Timmer AS, Buis DR, et al. Triclosan-containing sutures for the prevention of surgical site infection: a systematic review and meta-analysis. JAMA Netw Open. 2025;8(3):e250306.
34. 34. Konstantelias AA, Andriakopoulou CSI, Mourgela S. Triclosan-coated sutures for the prevention of surgical-site infections: a meta-analysis. Acta Chir Belg. 2017;117(3):137-48.
35. 35. Otto-Lambertz C, Decker L, Adams A, Yagdiran A, Eysel P. Can triclosan-coated sutures reduce the postoperative rate of wound infection? Data from a systematic review and meta-analysis. Surgery. 2023;174(3):638-46.
36. 36. Edwards JP, Ho AL, Tee MC, Dixon E, Ball CG. Wound protectors reduce surgical site infection: a meta-analysis of randomized controlled trials. Ann Surg. 2012;256(1):53-9.
37. 37. Zhang L, Elsolh B, Patel SV. Wound protectors in reducing surgical site infections in lower gastrointestinal surgery: an updated meta-analysis. Surg Endosc. 2018;32(3):1111-22.
38. 38. Gheorghe A, Calvert M, Pinkney TD, Fletcher BR, Bartlett DC, Hawkins WJ, et al. Systematic review of the clinical effectiveness of wound-edge protection devices in reducing surgical site infection in patients undergoing open abdominal surgery. Ann Surg. 2012;255(6):1017-29.
39. 39. Cooper HJ, Singh DP, Gabriel A, et al. Closed incision negative pressure therapy versus standard of care in reduction of surgical site complications: a systematic review and meta-analysis. Plast Reconstr Surg Glob Open. 2023;11(3):e4722.
40. 40. Groenen H, Jalalzadeh H, Buis DR, et al. Incisional negative pressure wound therapy for the prevention of surgical site infection: an up-to-date meta-analysis and trial sequential analysis. EClinicalMedicine. 2023;62:102105.
41. 41. Norman G, Shi C, Goh EL, et al. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev. 2022;4:CD009261.
42. 42. Hyldig N, Vinter CA, Kruse M, et al. Prophylactic incisional negative pressure wound therapy reduces the risk of surgical site infection after caesarean section in obese women: a pragmatic randomised clinical trial. BJOG. 2019;126(5):628-35.
43. 43. Hopf HW, Hunt TK, West JM, et al. Wound tissue oxygen tension predicts the risk of wound infection in surgical patients. Arch Surg. 1997;132(9):997-1004.
44. 44. Kurz A, Sessler DI, Lenhardt R; Study of Wound Infection and Temperature Group. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med. 1996;334(19):1209-15.
45. 45. Connelly L, Cramer E, DeMott Q, Piperno J, Coyne B, Winfield C, et al. The optimal time and method for surgical prewarming: a comprehensive review of the literature. J Perianesth Nurs. 2017;32(3):199-209.
46. 46. de Brito Poveda V, Clark AM, Galvão CM. A systematic review on the effectiveness of prewarming to prevent perioperative hypothermia. J Clin Nurs. 2013;22(7-8):906-18.
47. 47. Greif R, Akca O, Horn EP, Kurz A, Sessler DI. Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. N Engl J Med. 2000;342(3):161-7.
48. 48. Belda FJ, Aguilera L, García de la Asunción J, et al. Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial. JAMA. 2005;294(16):2035-42.
49. 49. Meyhoff CS, Wetterslev J, Jørgensen LN, et al. Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial. JAMA. 2009;302(14):1543-50.
50. 50. Ban KA, Minei JP, Laronga C, Haridas M, Jensen EH, Fry DE, et al. American College of Surgeons and Surgical Infection Society: surgical site infection guidelines, 2016 update. J Am Coll Surg. 2017;224(1):59-74.
51. 51. European Centre for Disease Prevention and Control. Protocol for the surveillance of surgical site infections and prevention indicators in European hospitals: HAI-Net SSI protocol version 2.3. Stockholm: ECDC; 2025.
52. 52. Lidwell OM, Lowbury EJ, Whyte W, Blowers R, Stanley SJ, Lowe D. Ultraclean air and antibiotics for prevention of postoperative infection. Acta Orthop Scand. 1987;58(1):4-13.
53. 53. Bischoff P, Kubilay NZ, Allegranzi B, Egger M, Gastmeier P. Effect of laminar airflow ventilation on surgical site infections: a systematic review and meta-analysis. Lancet Infect Dis. 2017;17(5):553-61.
54. 54. Lv Q, Lu Y, Wang H, Li X, Zhang W, Abdelrahim M, et al. The possible effect of different types of ventilation on reducing operation theatre infections: a meta-analysis. Ann R Coll Surg Engl. 2021;103(3):145-50.
55. 55. Ouyang X, Wang Q, Li X, et al. Laminar airflow ventilation systems in orthopaedic operating room do not prevent surgical site infections: a systematic review and meta-analysis. J Orthop Surg Res. 2023;18:572.
56. 56. McArdle C, Kearns M. Laminar air flow handling systems in the operating room. J Arthroplasty. 2019;34(5):849-54.
57. 57. Mostafalu P, Tamayol A, Rahimi R, et al. Smart bandage for monitoring and treatment of chronic wounds. Small. 2018;14(33):e1703509.
58. 58. Gunter RL, Fernandes-Taylor S, Rahman S, et al. Feasibility of an image-based mobile health protocol for postoperative wound monitoring. J Am Coll Surg. 2018;226(3):277-86.
59. 59. Gray LC, Armfield NR, Smith AC. Telemedicine for wound care: current practice and future potential. Wound Pract Res. 2010;18(4):158-63.
60. 60. Aldhoayan MD, Aljubran Y. Prediction of ICU patients' deterioration using machine learning techniques. Cureus. 2023;15(5):e38659.
61. 61. Thottakkara P, Ozrazgat-Baslanti T, Hupf BB, et al. Application of machine learning techniques to high-dimensional clinical data to forecast postoperative complications. PLoS One. 2016;11(5):e0155705.
62. 62. Senders JT, Staples PC, Karhade AV, et al. Machine learning and neurosurgical outcome prediction: a systematic review. World Neurosurg. 2018;109:476-86.e1.
63. 63. Van Boeckel TP, Gandra S, Ashok A, et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis. 2014;14(8):742-50.
64. 64. Yang X, Xiong Y, Ye Q, Hu J, Li D, Liu Z, Zhou P. Multi-drug-resistant organisms are the main pathogens of surgical-site infection after colorectal surgery: a retrospective study. Infect Prev Pract. 2026;8(2):100510.