Prevention of Surgical Infections
Over 2.4 million surgeries are performed annually in Australia and up to 15% of these procedures are complicated by infections involving the wound ("surgical site infections" “SSIs"). These infections are the leading cause of healthcare-associated infections and are the costliest; with healthcare budget estimates of $20,000 per SSI. SSIs represent a significant burden to patients, frequently necessitating prolonged hospitalisations, repeat operations and broad-spectrum antimicrobial therapy. These infections are also an important driver for the emergence of drug-resistant infections, which The World Health Organization has described as one of the most critical public health issues of our time.
The Surgical Infection Research Group, led by Dr Trisha Peel, conducts large-scale clinical trials and implementation science research investigating strategies to prevent surgical site infections. The overarching aims of this group are to: a) prevent the development of SSIs, integrating cutting-edge microbiology and genomics with large-scale clinical trials and; b) prevent harm and the emergence of antimicrobial resistance in patients undergoing surgery. This research traversed the translation pathway from Bench to Bedside through to Practice-Based Research and Policy. Clinical trials include the seminal NHMRC funded Australian Surgical Antibiotic Prophylaxis (ASAP) Trial. ASAP is one of the largest prophylaxis trials ever conducted, recruiting 4450 patients across 12 high-volume orthopaedic centres in Australia. The trial is the first trial to examine the clinical, economic and microbiological impact of combination prophylaxis with cefazolin and vancomycin in joint replacement surgery. The knowledge generated through this research will have a profound impact on international understanding and practice.
The Staphylococcus Carriage Study is a planned sub-study of the ASAP Trial and involves the collection of clinical specimens from enrolled patients (over 8500 specimens). The Staphylococcus Carriage Study is an unprecedented study examining the prevalence of immediate peri-operative carriage of Staphylococcus aureus and coagulase negative staphylococci in patient undergoing joint replacement surgery and will allow the examination of the impact of immediate staphylococcal peri-operative carriage on the incidence of SSIs. This research will also allow the characterisation of the role of the microbiome in the development of SSIs, defining the pathogenesis and examining the impact of preventative strategies on the microbiome.
The second focus of this group applies behavioural science and knowledge brokering approaches to translate evidence into practice. A major focus of this team is investigating strategies to improve up-take and adoption of evidence-based approaches for the prevention of SSIs. We work closely with our anaesthesiology and surgical stakeholders, as well as Health Services Researchers, to understand the barriers and drivers to uptake of evidence-based infection prevention strategies to inform decision-making approaches, education strategies and guide behaviour change interventions.
The ultimate goals of this research program are to improve understanding about how surgical site infections develop, how to best prevent these infections and how to ensure responsible, evidence-based use of antimicrobials.
A full list of publications can be found at Google Scholar
- Appropriateness of Surgical Antimicrobial Prophylaxis Practices in Australia.
- Ierano C, Thursky K, Marshall C, Koning S, James R, Johnson S, Imam N, Worth LJ, Peel T.
- JAMA Netw Open. 2019 Nov 1;2(11):e1915003. doi: 10.1001/jamanetworkopen.2019.15003.