S. A. Patel1, R. J. Kucejko1, J. L. Poggio1 1Drexel University College Of Medicine,Philadelphia, Pa, USA
Introduction: Human immunodeficiency virus (HIV) has been a vexing challenge to healthcare providers since its discovery. As medical therapy increases survival among people with an HIV infection, surgeons have been seeing an increasing number of HIV-infected patients with anorectal pathologies, including anal dysplasia and cancer. There is, however, no data on the incidence and risk factors for postoperative complications, such as surgical site infections (SSIs), in HIV patients undergoing elective anorectal procedures, nor is there data to suggest the administration of prophylactic antibiotics. Regular antibiotics are costly and have side effects that urge for accurate targeting of use; the purpose of this study was to review a HIV-positive patient population that has undergone anorectal surgery for dysplasia and assess the need for antibiotic prophylaxis.
Methods: A retrospective chart review was performed of all HIV positive patients seen as an outpatient in the Colorectal Surgery Division from 2007 to 2014. Basic demographics and clinical data such as date(s) of surgery, follow-up visit(s), and antibiotic prophylaxis, as well as preoperative CD4 count and HIV viral load, were recorded for 229 patients and 362 procedures. Postoperative exam notes were reviewed to determine the presence of an SSI. To analyze the data, patients were stratified according to CD4 count and viral load. The proportion of patients who received prophylactic antibiotics was assessed and the SSI rate was calculated. A chi-squared analysis was performed to assess whether SSI risk was elevated in this population.
Results: SSIs occurred in two of 193 (1.04%) cases for which antibiotic prophylaxis was not administered and in none of the 36 cases with antibiotic prophylaxis and available post-operative reports. One SSI occurred in a 51-year-old male with a preoperative CD4 count of 612/μL and viral load of zero. The other SSI occurred in 57-year-old female with an unknown CD4 count and viral load. A chi squared analysis showed the incidence of SSIs in the groups with and without antibiotic prophylaxis was not significantly different (p=0.540).
Conclusion: Our study found an SSI incidence of 1.04% in HIV-infected patients with CD4 counts above 50/μL, which does not suggest an elevated risk compared to the general population reported incidence of 3-11% for clean-contaminated wounds. Antibiotics are costly and have many side effects; based on our study, prophylactic antibiotics are not indicated for outpatient anorectal procedures in HIV patients with CD4 counts above 50/μL.