Clinical decision support system for the management of surgical site infections in trauma and orthopedic patients



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Abstract

BACKGROUND: Despite the availability of clinical practice guidelines (CPG) for the management of surgical site infections (SSI), data on the adherence to them in a real-world clinical practice in Russian hospitals remain limited, as well as the impact of non-adherence on outcomes in SSI patients has not been sufficiently studied.

AIM: To develop an electronic clinical decision support system (CDSS) for the SSI personalized surgical treatment and antimicrobial therapy, and to assess the compliance of the therapy provided with CPG in traumatology and orthopedics.

METHODS: A single-center retrospective continuous uncontrolled observational study was conducted to analyze data from patients hospitalized at the Federal State Budgetary Institution “N.N. Priorov National Medical Research Center of Traumatology and Orthopedics” from January 2024 to May 2025, who presented clinical signs of surgical site inflammation, fever (>37.5 °C) for ≥3 days after surgery, a positive bacteriological culture from the wound, or a consultation with clinical pharmacologist regarding antimicrobial therapy (AMT). The primary endpoints were CPG compliance of surgical tactics and AMT regarding drug choice, dosing and duration. Compliance assessment was performed using the CDSS by comparing prescriptions with established SSI treatment protocols in the whole group and in the acute and chronic infection subgroups.

RESULTS: Ninety patients were enrolled, of whom 84 met SSI criteria (31 with acute and 53 with chronic infection). Complete adherence to CPG was observed in 20 cases (24%) — 13 acute and 7 chronic SSI. In 25 cases (30%), the choice of antimicrobial drug did not match the recommended one, and in 7 cases (8%) the dosing regimen was inappropriate. In 58 cases (64%), the AMT duration was shorter than recommended; among these, 16 patients (28%) were not prescribed antibiotics for the outpatient. Patients with chronic infection were more likely to receive an shorter AMT course (p <0.0001) and an inappropriate drug (p=0.036) compared with acute cases. Microbiological culture samples were collected from 82 patients, 33% of which — during AMT.

CONCLUSION: In a trauma and orthopaedic hospital, there is a pronounced need for CDSS based on CPG and “seamlessly” integrated into clinicians’ workflows, particularly with regard to strategies for antimicrobial therapy.

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About the authors

Anton G. Nazarenko

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

Email: nazarenkoag@cito-priorov.ru
ORCID iD: 0000-0003-1314-2887
SPIN-code: 1402-5186

Corresponding Member of the Russian Academy of Sciences, MD, Dr. Sci. (Medicine), professor of RAS

Russian Federation, 10 Priorova st, Moscow, 127299

Elena B. Kleimenova

Priorov National Medical Research Center for Traumatology and Orthopedics

Email: KleymenovaEB@cito-priorov.ru
ORCID iD: 0000-0002-8745-6195
SPIN-code: 2037-7164

MD, Dr. Sci. (Medicine), рrofessor

Russian Federation, 10 Priorova st, Moscow, 127299

Natalia I. Sobur

Priorov National Medical Research Center for Traumatology and Orthopedics

Author for correspondence.
Email: nisoburm.d@gmail.com
ORCID iD: 0009-0007-8100-4079
SPIN-code: 9916-5815

MD

Russian Federation, 10 Priorova st, Moscow, 127299

Archil V. Tsiskarashvili

Priorov National Medical Research Center for Traumatology and Orthopedics

Email: TsiskarashviliAV@cito-priorov.ru
ORCID iD: 0000-0003-1721-282X
SPIN-code: 2312-1002

MD, MD, Cand. Sci. (Medicine)

Russian Federation, 10 Priorova st, Moscow, 127299

Mikhail A. Dronov

Priorov National Medical Research Center for Traumatology and Orthopedics; Lomonosov Moscow State University

Email: mikhail.dronov@gmail.com
ORCID iD: 0000-0002-4090-2928
SPIN-code: 8710-6504
Russian Federation, Москва

Vitaly A. Otdelenov

Priorov National Medical Research Center of Traumatology and Orthopedics; Russian Medical Academy of Continuing Professional Education

Email: vitotd@yandex.ru
ORCID iD: 0000-0003-0623-7263
SPIN-code: 8357-5770

MD, Сand. Sci. (Medicine)

Russian Federation, 10 Priorova str., 127299 Moscow;

Ekaterina S. Yurchenkova

Priorov National Medical Research Center for Traumatology and Orthopedics

Email: YurchenkovaES@cito-priorov.ru
ORCID iD: 0009-0006-2350-7201
SPIN-code: 4933-9999
Russian Federation, Moscow

Liubov P. Yashina

Priorov National Medical Research Center for Traumatology and Orthopedics

Email: YashinaLP@cito-priorov.ru
ORCID iD: 0000-0003-1357-0056
SPIN-code: 1910-0484

Cand. Sci. (Biol.)

Russian Federation, Moscow

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