Background: Almost all surgeries for ulcerative colitis (UC) are performed under immunosuppressive conditions. Immunomodulators or biologics, with the exception of corticosteroids, do not appear to be risk factors for post-operative infectious complications. However, many patients are on multiagent immunosuppressive therapy at the time of surgery. Therefore, we evaluated the influence of pre-operative multiple immunosuppressives on the occurrence of surgical site infection (SSI) in UC. Methods: We reviewed surveillance data from 181 patients who underwent restorative proctocolectomy between January 2012 and March 2014. The incidences of SSI and the possible risk factors among patients receiving different immunosuppressive therapies were compared and analyzed. Results: The incidence of incisional (INC) SSI was 13.3% and that of organ/space (O/S) SSI was 7.2%. The number of immunosuppressives did not significantly correlate with each incidence. Total prednisolone administration ≥12,000 mg (OR 2.6) and an American Society of Anesthesiologists score ≥3 (OR 2.8) were shown to be independent risk factors for overall SSI, whereas corticosteroid use in INC SSI (OR 17.4) and severe disease (OR 5.2) and a large amount of blood loss (OR 3.9) in O/S SSI were identified as risk factors. Conclusion: Although a correlation between multiple immunosuppressive therapy and SSIs was not found, it is not recommended that all patients be treated with multiple immunosuppressive therapy. Treatment strategy should be applied based on the patient's condition.

Truelove SC, Jewell DP: Intensive intravenous regimen for severe attacks of ulcerative colitis. Lancet 1974;1:1067-1070.
Järnerot G, Rolny P, Sandberg-Gertzén H: Intensive intravenous treatment of ulcerative colitis. Gastroenterology 1985;89:1005-1013.
Gustavsson A, Halfvarson J, Magnuson A, Sandberg-Gertzén H, Tysk C, Järnerot G: Long-term colectomy rate after intensive intravenous corticosteroid therapy for ulcerative colitis prior to the immunosuppressive treatment era. Am J Gastroenterol 2007;102:2513-2519.
Aratari A, Papi C, Clemente V, Moretti A, Luchetti R, Koch M, Capurso L, Caprilli R: Colectomy rate in acute severe ulcerative colitis in the infliximab era. Dig Liver Dis 2008;40:821-826.
Actis GC, Fadda M, David E, Sapino A: Colectomy rate in steroid-refractory colitis initially responsive to cyclosporin: a long-term retrospective cohort study. BMC Gastroenterol 2007;7:13.
Lichtiger S, Present DH, Kornbluth A, Gelernt I, Bauer J, Galler G, Michelassi F, Hanauer S: Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med 1994;330:1841-1845.
D'Haens G, Lemmens L, Geboes K, Vandeputte L, Van Acker F, Mortelmans L, Peeters M, Vermeire S, Penninckx F, Nevens F, Hiele M, Rutgeerts P: Intravenous cyclosporine versus intravenous corticosteroids as single therapy for severe attacks of ulcerative colitis. Gastroenterology 2001;120:1323-1329.
Sands BE, Tremaine WJ, Sandborn WJ, Rutgeerts PJ, Hanauer SB, Mayer L, Targan SR, Podolsky DK: Infliximab in the treatment of severe, steroid-refractory ulcerative colitis: a pilot study. Inflamm Bowel Dis 2001;7:83-88.
Järnerot G, Hertervig E, Friis-Liby I, Blomquist L, Karlén P, Grännö C, Vilien M, Ström M, Danielsson A, Verbaan H, Hellström PM, Magnuson A, Curman B: Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology 2005;128:1805-1811.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR: Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250-278; quiz 279-280.
Weiss CA 3rd, Statz CL, Dahms RA, Remucal MJ, Dunn DL, Beilman GJ: Six years of surgical wound infection surveillance at a tertiary care center: review of the microbiologic and epidemiological aspects of 20,007 wounds. Arch Surg 1999;134:1041-1048.
Olson MM, Lee JT Jr: Continuous, 10-year wound infection surveillance. Results, advantages, and unanswered questions. Arch Surg 1990;125:794-803.
Uchino M, Ikeuchi H, Tsuchida T, Nakajima K, Tomita N, Takesue Y: Surgical site infection following surgery for inflammatory bowel disease in patients with clean-contaminated wounds. World J Surg 2009;33:1042-1048.
Ahn HS, Lee SK, Kim HJ, Jang JY, Joo KR, Dong SH, Kim BH, Lee JI, Chang YW, Chang R: [Risk of postoperative infection in patients with inflammatory bowel disease]. Korean J Gastroenterol 2006;48:306-312.
Aberra FN, Lewis JD, Hass D, Rombeau JL, Osborne B, Lichtenstein GR: Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients. Gastroenterology 2003;125:320-327.
Subramanian V, Pollok RC, Kang JY, Kumar D: Systematic review of postoperative complications in patients with inflammatory bowel disease treated with immunomodulators. Br J Surg 2006;93:793-799.
Uchino M, Ikeuchi H, Matsuoka H, Bando T, Ichiki K, Nakajima K, Tomita N, Takesue Y: Infliximab administration prior to surgery does not increase surgical site infections in patients with ulcerative colitis. Int J Colorectal Dis 2013;28:1295-1306.
Nelson R, Liao C, Fichera A, Rubin DT, Pekow J: Rescue therapy with cyclosporine or infliximab is not associated with an increased risk for postoperative complications in patients hospitalized for severe steroid-refractory ulcerative colitis. Inflamm Bowel Dis 2014;20:14-20.
Uchino M, Ikeuchi H, Matsuoka H, Takahashi Y, Tomita N, Takesue Y: Surgical site infection and validity of staged surgical procedure in emergent/urgent surgery for ulcerative colitis. Int Surg 2013;98:24-32.
Smith RL, Bohl JK, McElearney ST, et al: Wound infection after elective colorectal resection. Ann Surg 2004;239:599-605; discussion 605-607.
Schroeder KW, Tremaine WJ, Ilstrup DM: Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med 1987;317:1625-1629.
Truelove SC, Witts LJ: Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J 1955;2:1041-1045.
Hanauer SB: Inflammatory bowel disease. N Engl J Med 1996;334:841-848.
Kornbluth A, Sachar DB; Practice Parameters Committee of the American College of Gastroenterology: Ulcerative colitis practice guidelines in adults: American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 2010;105:501-523; quiz 524.
Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG, Banerjee SN, Edwards JR, Tolson JS, Henderson TS, et al: Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 1991;91:152S-157S.
Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG: CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606-608.
Petrosillo N, Drapeau CM, Nicastri E, Martini L, Ippolito G, Moro ML; ANIPIO: Surgical site infections in Italian hospitals: a prospective multicenter study. BMC Infect Dis 2008;8:34.
Watanabe A, Kohnoe S, Shimabukuro R, Yamanaka T, Iso Y, Baba H, Higashi H, Orita H, Emi Y, Takahashi I, Korenaga D, Maehara Y: Risk factors associated with surgical site infection in upper and lower gastrointestinal surgery. Surg Today 2008;38:404-412.
Madbouly KM, Senagore AJ, Remzi FH, Delaney CP, Waters J, Fazio VW: Perioperative blood transfusions increase infectious complications after ileoanal pouch procedures (IPAA). Int J Colorectal Dis 2006;21:807-813.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.