Surgical site infections – an updated review of guidelines in the light of new scientific data
DOI:
https://doi.org/10.12775/JEHS.2023.28.01.002Keywords
surgical wound, postoperative complications, surgical site infection (SSI), surgical wound infection, infection, perioperative care, prehabilitationAbstract
Surgical site infections are important and still more growing burden in 2023. WHO estimated that SSIs are one of the most common and frequent healthcare associated infections (HAI), and in the world’s perspective, it can occur up to 10% after surgeries [1]. The knowledge about preliminary and novel ways of diagnosis and treatment and prevention of this disease are important in improving outcomes. Reducing the amount of complications after surgeries is crucial in helping with the recovery and it is an outcome of both proper prehabilitation and safe surgical protocols . Especially focus on the preventive measures for SSI, early diagnosis and aggressive treatment can really improve overall survival, lower the incidence of further complications (including sepsis), and improve patients recovery. This paper summarizes the current guidelines indications as well as their reflection in novel published data.
References
World Health Organization (WHO), Global guidelines for the prevention of surgical site infection, 2nd ed. Geneva: World Health Organization, 2018. Accessed: Apr. 02, 2023. [Online]. Available: https://apps.who.int/iris/handle/10665/277399
C. A. Umscheid, M. D. Mitchell, J. A. Doshi, R. Agarwal, K. Williams, and P. J. Brennan, ‘Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs’, Infect Control Hosp Epidemiol, vol. 32, no. 2, pp. 101–114, Feb. 2011, doi: 10.1086/657912.
World Health Organization (WHO), ‘Updated systematic review – WHO unpublished data’. World Health Organization, 2017. [Online]. Available: https://openwho.org/courses/IPC-SSI-EN/items/58dm4aVw9cUEkEFGTWOO43
B. Allegranzi et al., ‘Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis’, The Lancet, vol. 377, no. 9761, pp. 228–241, Jan. 2011, doi: 10.1016/S0140-6736(10)61458-4.
D. J. Anderson et al., ‘Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update’, Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America, vol. 35, no. 6, p. 605, Jun. 2014, doi: 10.1086/676022.
R. D. Scott, The Direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention. in Stephen B. Thacker CDC Library collection. 2009. Accessed: Apr. 06, 2023. [Online]. Available: https://stacks.cdc.gov/view/cdc/11550
European Centre for Disease Prevention and Control, Annual Epidemiological Report 2016 – Surgical site infections. [Internet] Stockholm: ECDC, 2016. Accessed: Apr. 02, 2023. [Online]. Available: https://www.ecdc.europa.eu/en/publications-data/surgical-site-infections-annual-epidemiological-report-2016-2014-data
World Health Organization (WHO), Report on the burden of endemic health care-associated infection worldwide. Geneva: World Health Organization, 2011. Accessed: Apr. 11, 2023. [Online]. Available: https://apps.who.int/iris/handle/10665/80135
WHO Patient Safety and World Health Organization (WHO), ‘WHO guidelines for safe surgery 2009: safe surgery saves lives’, Safe surgery saves lives, no. WHO/IER/PSP/2008.08-1E, p. 133, 2009.
K. A. Ban et al., ‘American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update’, J Am Coll Surg, vol. 224, no. 1, pp. 59–74, Jan. 2017, doi: 10.1016/j.jamcollsurg.2016.10.029.
National Healthcare Safety Network, Surgical Site Infection (SSI) Event. Atlanta: Centers for Disease Control and Prevention, 2023. [Online]. Available: https://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf
National Healthcare Safety Network, ‘CDC/NHSN Surveillance Definitions for Specific Types of Infections’, Centers for Disease Control and Prevention, 2023, p. 30. [Online]. Available: https://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf
A. J. Mangram, T. C. Horan, M. L. Pearson, L. C. Silver, W. R. Jarvis, and The Hospital Infection Control Practices Advisory Committee, ‘Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee’, Infect. Control Hosp. Epidemiol., vol. 20, no. 4, pp. 247–280, Apr. 1999, doi: 10.1086/501620.
T. C. Horan, R. P. Gaynes, W. J. Martone, W. R. Jarvis, and T. G. Emori, ‘CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections’, Am J Infect Control, vol. 20, no. 5, pp. 271–274, Oct. 1992, doi: 10.1016/s0196-6553(05)80201-9.
F. Carli and C. Scheede-Bergdahl, ‘Prehabilitation to enhance perioperative care’, Anesthesiol Clin, vol. 33, no. 1, pp. 17–33, Mar. 2015, doi: 10.1016/j.anclin.2014.11.002.
B. Siczyńska, S. Miętkiewicz, and D. Dyk, ‘Analysis of surgical site infection risk factors and methods of their modification’, Pielęgniarstwo Chirurgiczne i Angiologiczne/Surgical and Vascular Nursing, vol. 8, no. 2, pp. 56–61, 2014.
M. K. Hreńczuk, T. Piątek, M. Kosieradzki, and P. Małkowski, ‘Zakażenie miejsca operowanego u chorych po transplantacji nerki - zadania pielęgniarki w profilaktyce’ [Surgical site infection in patients after kidney transplantation - nurse’s tasks in prevention], Forum Nefrologiczne, vol. 12, no. 1, 2019, Accessed: Apr. 14, 2023. [Online]. Available: https://ppm.edu.pl/info/article/WUM190c444947d24585970c0758bf0f976a/
National Institute for Health and Care Excellence (NICE), Surgical site infections: prevention and treatment. in National Institute for Health and Care Excellence: Clinical Guidelines. London: National Institute for Health and Care Excellence (NICE), 2020. Accessed: Apr. 08, 2023. [Online]. Available: http://www.ncbi.nlm.nih.gov/books/NBK542473/
J. M. Torpy, A. Burke, and R. M. Glass, ‘Wound Infections’, JAMA, vol. 294, no. 16, p. 2122, Oct. 2005, doi: 10.1001/jama.294.16.2122.
S. I. Berríos-Torres et al., ‘Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017’, JAMA Surg, vol. 152, no. 8, pp. 784–791, Aug. 2017, doi: 10.1001/jamasurg.2017.0904.
P. Jeske, B. Wojtera, and T. Banasiewicz, ‘Prehabilitacja – obecna rola w chirurgii’ [Prehabilitation - current role in surgery], Pol Przegl Chir, vol. 94, no. 3, pp. 64–72, Feb. 2022, doi: 10.5604/01.3001.0015.7340.
G. Bousquet-Dion et al., ‘Evaluation of supervised multimodal prehabilitation programme in cancer patients undergoing colorectal resection: a randomized control trial’, Acta Oncol, vol. 57, no. 6, pp. 849–859, Jun. 2018, doi: 10.1080/0284186X.2017.1423180.
National Institute for Health and Care Excellence (NICE), Perioperative care in adults. in National Institute for Health and Care Excellence: Guidelines. London: National Institute for Health and Care Excellence (NICE), 2020. Accessed: Apr. 15, 2023. [Online]. Available: http://www.ncbi.nlm.nih.gov/books/NBK561982/
K. A. Ban et al., ‘Executive Summary of the American College of Surgeons/Surgical Infection Society Surgical Site Infection Guidelines—2016 Update’, Surgical Infections, vol. 18, no. 4, pp. 379–382, May 2017, doi: 10.1089/sur.2016.214.
C. Gillis et al., ‘Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: A Systematic Review and Meta-analysis’, Gastroenterology, vol. 155, no. 2, pp. 391-410.e4, Aug. 2018, doi: 10.1053/j.gastro.2018.05.012.
T. Mazaki, Y. Ishii, and I. Murai, ‘Immunoenhancing enteral and parenteral nutrition for gastrointestinal surgery: a multiple-treatments meta-analysis’, Ann Surg, vol. 261, no. 4, pp. 662–669, Apr. 2015, doi: 10.1097/SLA.0000000000000935.
C. Gillis et al., ‘Colorectal cancer patients with malnutrition suffer poor physical and mental health before surgery’, Surgery, vol. 170, no. 3, pp. 841–847, Sep. 2021, doi: 10.1016/j.surg.2021.04.003.
F. Briet, C. Twomey, and K. N. Jeejeebhoy, ‘Effect of malnutrition and short-term refeeding on peripheral blood mononuclear cell mitochondrial complex I activity in humans’, The American Journal of Clinical Nutrition, vol. 77, no. 5, pp. 1304–1311, May 2003, doi: 10.1093/ajcn/77.5.1304.
C. Gillis and S. M. Phillips, ‘Protein for the Pre-Surgical Cancer Patient: a Narrative Review’, Curr Anesthesiol Rep, vol. 12, no. 1, pp. 138–147, Mar. 2022, doi: 10.1007/s40140-021-00494-x.
K. Tojek, Z. Banaszkiewicz, and J. Budzyński, ‘Body composition among patients undergoing surgery for colorectal cancer’, pg, vol. 16, no. 1, pp. 47–55, 2021, doi: 10.5114/pg.2021.104736.
J. Durrand, S. J. Singh, and G. Danjoux, ‘Prehabilitation’, Clin Med (Lond), vol. 19, no. 6, pp. 458–464, Nov. 2019, doi: 10.7861/clinmed.2019-0257.
M. A. West, F. Carli, and M. P. W. Grocott, ‘Editorial: Personalised multimodal prehabilitation in cancer’, Front Oncol, vol. 12, p. 1086739, 2022, doi: 10.3389/fonc.2022.1086739.
C. Yue et al., ‘The impact of perioperative glutamine-supplemented parenteral nutrition on outcomes of patients undergoing abdominal surgery: a meta-analysis of randomized clinical trials’, Am Surg, vol. 79, no. 5, pp. 506–513, May 2013.
S. Kurosawa and M. Kato, ‘Anesthetics, immune cells, and immune responses’, J Anesth, vol. 22, no. 3, pp. 263–277, 2008, doi: 10.1007/s00540-008-0626-2.
A. M. Spagnolo, G. Ottria, D. Amicizia, F. Perdelli, and M. L. Cristina, ‘Operating theatre quality and prevention of surgical site infections’, J Prev Med Hyg, vol. 54, no. 3, pp. 131–137, Sep. 2013.
L. H. Rosenberger, A. D. Politano, and R. G. Sawyer, ‘The Surgical Care Improvement Project and Prevention of Post-Operative Infection, Including Surgical Site Infection’, Surg Infect (Larchmt), vol. 12, no. 3, pp. 163–168, Jun. 2011, doi: 10.1089/sur.2010.083.
World Health Organization (WHO) and WHO Patient Safety, ‘WHO guidelines on hand hygiene in health care’, World Health Organization, WHO/IER/PSP/2009/01, 2009. Accessed: Apr. 12, 2023. [Online]. Available: https://apps.who.int/iris/handle/10665/44102
G. P. Privitera et al., ‘Skin antisepsis with chlorhexidine versus iodine for the prevention of surgical site infection: A systematic review and meta-analysis’, Am J Infect Control, vol. 45, no. 2, pp. 180–189, Feb. 2017, doi: 10.1016/j.ajic.2016.09.017.
Health Protection Scotland, ‘Targeted literature review. What are the key infection prevention and control recommendations to inform a surgical site infection (SSI) prevention quality improvement tool?’, Edinburgh, version 3.0, Feb. 2015. Accessed: Apr. 14, 2023. [Online]. Available: https://www.nss.nhs.scot/media/2208/surgical-site-infection-ssi-prevention-quality-improvement-tool.pdf
National Institute for Health and Care Excellence (NICE), Hypothermia: prevention and management in adults having surgery. in National Institute for Health and Care Excellence: Guidelines. London: National Institute for Health and Care Excellence (NICE), 2016. Accessed: Apr. 15, 2023. [Online]. Available: http://www.ncbi.nlm.nih.gov/books/NBK554181/
H. W. Hopf, T. K. Hunt, and N. Rosen, ‘Supplemental oxygen and risk of surgical site infection’, JAMA, vol. 291, no. 16, pp. 1956; author reply 1958-1959, Apr. 2004, doi: 10.1001/jama.291.16.1956-a.
M. P. W. Grocott, T. E. Miller, M. (Monty) G. Mythen, and D. S. Martin, ‘Perioperative oxygen therapy: meaningful outcomes and unintended consequences?’, British Journal of Anaesthesia, vol. 123, no. 1, pp. e6–e7, Jul. 2019, doi: 10.1016/j.bja.2019.03.035.
R. Greif, O. Akça, E. P. Horn, A. Kurz, D. I. Sessler, and Outcomes Research Group, ‘Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection’, N Engl J Med, vol. 342, no. 3, pp. 161–167, Jan. 2000, doi: 10.1056/NEJM200001203420303.
P. G. Rodriguez, F. N. Felix, D. T. Woodley, and E. K. Shim, ‘The role of oxygen in wound healing: a review of the literature’, Dermatol Surg, vol. 34, no. 9, pp. 1159–1169, Sep. 2008, doi: 10.1111/j.1524-4725.2008.34254.x.
J. S. Cooper, P. Phuyal, and N. Shah, ‘Oxygen Toxicity’, in StatPearls, Treasure Island (FL): StatPearls Publishing, 2023. Accessed: Apr. 14, 2023. [Online]. Available: http://www.ncbi.nlm.nih.gov/books/NBK430743/
K. Mattishent et al., ‘Safety of 80% vs 30-35% fraction of inspired oxygen in patients undergoing surgery: a systematic review and meta-analysis’, Br J Anaesth, vol. 122, no. 3, pp. 311–324, Mar. 2019, doi: 10.1016/j.bja.2018.11.026.
L. Dalfino, M. T. Giglio, F. Puntillo, M. Marucci, and N. Brienza, ‘Haemodynamic goal-directed therapy and postoperative infections: earlier is better. a systematic review and meta-analysis’, Crit Care, vol. 15, no. 3, p. R154, 2011, doi: 10.1186/cc10284.
National Institute for Health and Care Excellence (NICE), Intravenous fluid therapy in adults in hospital. in National Institute for Health and Care Excellence: Guidelines. London: National Institute for Health and Care Excellence (NICE), 2017. Accessed: Apr. 15, 2023. [Online]. Available: http://www.ncbi.nlm.nih.gov/books/NBK554180/
N. A. Joslyn, N. O. Esmonde, R. G. Martindale, J. Hansen, I. Khansa, and J. E. Janis, ‘Evidence-Based Strategies for the Prehabilitation of the Abdominal Wall Reconstruction Patient’, Plast Reconstr Surg, vol. 142, no. 3 Suppl, pp. 21S-29S, Sep. 2018, doi: 10.1097/PRS.0000000000004835.
A. Thorell et al., ‘Surgery-induced insulin resistance in human patients: relation to glucose transport and utilization’, Am J Physiol, vol. 276, no. 4, pp. E754-761, Apr. 1999, doi: 10.1152/ajpendo.1999.276.4.E754.
N. Tewari et al., ‘Postoperative inflammation and insulin resistance in relation to body composition, adiposity and carbohydrate treatment: A randomised controlled study’, Clinical Nutrition, vol. 38, no. 1, pp. 204–212, Feb. 2019, doi: 10.1016/j.clnu.2018.01.032.
O. Ljungqvist, J. Nygren, and A. Thorell, ‘Insulin resistance and elective surgery’, Surgery, vol. 128, no. 5, pp. 757–760, Nov. 2000, doi: 10.1067/msy.2000.107166.
A. Thorell, J. Nygren, and O. Ljungqvist, ‘Insulin resistance: a marker of surgical stress’, Curr Opin Clin Nutr Metab Care, vol. 2, no. 1, pp. 69–78, Jan. 1999, doi: 10.1097/00075197-199901000-00012.
C. D. Toon, S. Sinha, B. R. Davidson, and K. S. Gurusamy, ‘Early versus delayed post-operative bathing or showering to prevent wound complications’, Cochrane Database Syst Rev, vol. 2015, no. 7, p. CD010075, Jul. 2015, doi: 10.1002/14651858.CD010075.pub3.
A. Kirby and N. Santoni, ‘Antibiotic resistance in Enterobacteriaceae: what impact on the efficacy of antibiotic prophylaxis in colorectal surgery?’, J Hosp Infect, vol. 89, no. 4, Apr. 2015, doi: 10.1016/j.jhin.2014.11.016.
B. Dubinsky-Pertzov et al., ‘Carriage of Extended-spectrum Beta-lactamase-producing Enterobacteriaceae and the Risk of Surgical Site Infection After Colorectal Surgery: A Prospective Cohort Study’, Clinical Infectious Diseases, vol. 68, no. 10, pp. 1699–1704, Feb. 2019, doi: 10.1093/cid/ciy768.
A. Nutman et al., ‘Personalized Ertapenem Prophylaxis for Carriers of Extended-spectrum β-Lactamase–producing Enterobacteriaceae Undergoing Colorectal Surgery’, Clinical Infectious Diseases, vol. 70, no. 9, pp. 1891–1897, Apr. 2020, doi: 10.1093/cid/ciz524.
M. Afzaal et al., ‘Human gut microbiota in health and disease: Unveiling the relationship’, Frontiers in microbiology, vol. 13, Sep. 2022, doi: 10.3389/fmicb.2022.999001.
G. Tzikos et al., ‘A Four-Probiotic Regime to Reduce Surgical Site Infections in Multi-Trauma Patients’, Nutrients, vol. 14, no. 13, p. 2620, Jun. 2022, doi: 10.3390/nu14132620.
J. Veziant, M. Bonnet, B. V. Occean, C. Dziri, B. Pereira, and K. Slim, ‘Probiotics/Synbiotics to Reduce Infectious Complications after Colorectal Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials’, Nutrients, vol. 14, no. 15, p. 3066, Jul. 2022, doi: 10.3390/nu14153066.
J. Zeng et al., ‘The effect of pro/synbiotics on postoperative infections in colorectal cancer patients: A systematic review and meta-analysis’, Complement Ther Clin Pract, vol. 43, p. 101370, May 2021, doi: 10.1016/j.ctcp.2021.101370.
M. Nunns et al., ‘Multicomponent hospital-led interventions to reduce hospital stay for older adults following elective surgery: a systematic review’, Health Serv Deliv Res, vol. 7, no. 40, pp. 1–178, Dec. 2019, doi: 20191203131325118.
P.-Y. Li, D. Yang, D. Liu, S.-J. Sun, and L.-Y. Zhang, ‘Reducing Surgical Site Infection with Negative-Pressure Wound Therapy After Open Abdominal Surgery: A Prospective Randomized Controlled Study’, Scand J Surg, vol. 106, no. 3, pp. 189–195, Sep. 2017, doi: 10.1177/1457496916668681.
A. A. Javed et al., ‘Negative Pressure Wound Therapy for Surgical-site Infections: A Randomized Trial’, Annals of Surgery, vol. 269, no. 6, p. 1034, Jun. 2019, doi: 10.1097/SLA.0000000000003056.
J. Meyer, E. Roos, Z. Abbassi, N. C. Buchs, F. Ris, and C. Toso, ‘Prophylactic Negative-pressure Wound Therapy Prevents Surgical Site Infection in Abdominal Surgery: An Updated Systematic Review and Meta-analysis of Randomized Controlled Trials and Observational Studies’, Clinical Infectious Diseases, vol. 73, no. 11, pp. e3804–e3813, Dec. 2021, doi: 10.1093/cid/ciaa1203.
J. Shiroky, E. Lillie, H. Muaddi, M. Sevigny, W. J. Choi, and P. J. Karanicolas, ‘The impact of negative pressure wound therapy for closed surgical incisions on surgical site infection: A systematic review and meta-analysis’, Surgery, vol. 167, no. 6, pp. 1001–1009, Jun. 2020, doi: 10.1016/j.surg.2020.01.018.
F. E. E. De Vries et al., ‘A systematic review and meta-analysis including GRADE qualification of the risk of surgical site infections after prophylactic negative pressure wound therapy compared with conventional dressings in clean and contaminated surgery’, Medicine (Baltimore), vol. 95, no. 36, p. e4673, Sep. 2016, doi: 10.1097/MD.0000000000004673.
J. Meyer, E. Roos, Z. Abbassi, C. Toso, C. N. Buchs, and F. Ris, ‘Does prophylactic negative pressure wound therapy prevent surgical site infection in abdominal surgery?’, J Wound Care, vol. 32, no. Sup1, pp. S28–S34, Jan. 2023, doi: 10.12968/jowc.2023.32.Sup1.S28.
A. Älgå and J. Malmstedt, ‘Prophylactic Negative-Pressure Wound Therapy After Laparotomy: Ongoing Discussion Following High-Quality Systematic Review’, World J Surg, Feb. 2023, doi: 10.1007/s00268-023-06948-z.
H. Al Chalabi, J. Larkin, B. Mehigan, and P. McCormick, ‘A systematic review of laparoscopic versus open abdominal incisional hernia repair, with meta-analysis of randomized controlled trials’, Int J Surg, vol. 20, pp. 65–74, Aug. 2015, doi: 10.1016/j.ijsu.2015.05.050.
N. Kulkarni and T. Arulampalam, ‘Laparoscopic surgery reduces the incidence of surgical site infections compared to the open approach for colorectal procedures: a meta-analysis’, Tech Coloproctol, vol. 24, no. 10, pp. 1017–1024, Oct. 2020, doi: 10.1007/s10151-020-02293-8.
M. Utsumi et al., ‘Differences in risk factors for surgical site infection between laparotomy and laparoscopy in gastrointestinal surgery’, PLOS ONE, vol. 17, no. 9, p. e0274887, Sep. 2022, doi: 10.1371/journal.pone.0274887.
T. Hoffman, P. Shitrit, and M. Chowers, ‘Risk factors for surgical site infections following open versus laparoscopic colectomies: a cohort study’, BMC Surg, vol. 21, p. 376, Oct. 2021, doi: 10.1186/s12893-021-01379-w.
D. A. Caroff et al., ‘Association of Open Approach vs Laparoscopic Approach With Risk of Surgical Site Infection After Colon Surgery’, JAMA Network Open, vol. 2, no. 10, p. e1913570, Oct. 2019, doi: 10.1001/jamanetworkopen.2019.13570.
Y. Kagawa et al., ‘The association between the increased performance of laparoscopic colon surgery and a reduced risk of surgical site infection’, Surg Today, vol. 49, no. 6, pp. 474–481, Jun. 2019, doi: 10.1007/s00595-019-1760-1.
J. L. Lavanchy, S. E. Buff, A. Kohler, D. Candinas, and G. Beldi, ‘Long-term results of laparoscopic versus open intraperitoneal onlay mesh incisional hernia repair: a propensity score-matched analysis’, Surg Endosc, vol. 33, no. 1, pp. 225–233, Jan. 2019, doi: 10.1007/s00464-018-6298-6.
M. M. Mahmood, A. Shahab, and M. A. Razzaq, ‘Surgical Site Infection in Open Versus Laparoscopic Appendectomy’, Pakistan Journal of Medical & Health Sciences, vol. 10, no. 3, pp. 1076–1078, Sep. 2016.
R. Aimaq, G. Akopian, and H. S. Kaufman, ‘Surgical Site Infection Rates in Laparoscopic Versus Open Colorectal Surgery’, The American SurgeonTM, vol. 77, no. 10, pp. 1290–1294, Oct. 2011, doi: 10.1177/000313481107701003.
C. Gillis, O. Ljungqvist, and F. Carli, ‘Prehabilitation, enhanced recovery after surgery, or both? A narrative review’, British Journal of Anaesthesia, vol. 128, no. 3, pp. 434–448, Mar. 2022, doi: 10.1016/j.bja.2021.12.007.
E. M. Minnella, K. Drummond, and F. Carli, ‘The impact of prehabilitation on surgical outcomes’, Annals of Esophagus, vol. 4, no. 0, Art. no. 0, Mar. 2021, doi: 10.21037/aoe-2020-15.
C. L. Ventola, ‘The Antibiotic Resistance Crisis’, P T, vol. 40, no. 4, pp. 277–283, Apr. 2015.
M. M. Aljeldah, ‘Antimicrobial Resistance and Its Spread Is a Global Threat’, Antibiotics, vol. 11, no. 8, Art. no. 8, Aug. 2022, doi: 10.3390/antibiotics11081082.
C. J. L. Murray et al., ‘Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis’, The Lancet, vol. 399, no. 10325, pp. 629–655, Feb. 2022, doi: 10.1016/S0140-6736(21)02724-0.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Sebastian Lechowski, Aleksandra Kułakowska, Philip Kłakowicz, Bartłomiej Lepczyński, Agnieszka Siedlak
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 792
Number of citations: 0
