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Surgical site infections

current management and role of new antibiotics

Mellinghoff, Sibylle C.a , b; Otto, Christinac; Cornely, Oliver A.a , b , d

Current Opinion in Infectious Diseases: October 2019 - Volume 32 - Issue 5 - p 517–522
doi: 10.1097/QCO.0000000000000589
SPECIAL COMMENTARY: Edited by Matteo Bassetti
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Purpose of review Management of SSI comprises prevention, extensive diagnosis, and appropriate treatment as well as follow-up. All these are interrelated matters. This review gives a brief update on the latest developments in the field, specifically on new antibiotics that may find a place in this complex field.

Recent findings Avibactam and dalbavancin are novel antiinfectives. Although randomized controlled trials in SSI are lacking to date, preliminary data show that new drugs may be alternatives to existing treatment. Currently, they should be used only on the ground of susceptibility testing, and if standard drugs are inappropriate.

Summary Correct diagnosis of SSI depends on the type of procedure performed. However, early detection is of great importance for proper management across all surgical interventions. The management of SSI includes consistent antibiotic therapy, wound drainage, and rigorous wound debridement as appropriate. Specific wound management thereafter depends on the location and nature of infection. If available, culture findings guide changes in antibiotic therapy. Avibactam and dalbavancin are novel antiinfectives that should be used on ground of susceptibility testing in the absence of appropriate alternatives. Follow-up is particularly important in patients with prosthesis in place. The most promising approach of postdischarge surveillance is a matter of ongoing debate.

aDepartment I for Internal Medicine, Excellence Center for Medical Mycology (ECMM)

bCECAD Cluster of Excellence

cDepartment of Orthopedics and Trauma Surgery

dClinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany

Correspondence to Oliver A. Cornely, Kerpener Street 62, 50937 Cologne, Germany. E-mail: oliver.cornely@uk-koeln.de

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