Glycemic control and prevention of surgical site infection

Background: Stress hyperglycemia is associated with increased risk of surgical site infections (SSIs). Use of strict or tight glycemic control with intensive insulin therapy to prevent SSIs is controversial. Methods: Review of pertinent English-language literature. Results: There is a large body of literature supporting an association between stress hyperglycemia and SSIs. The quality of evidence from randomized controlled trials and meta-analyses that strict glycemic control reduces SSIs or any infections is low, and the strength of recommendation for strict glycemic control is weak due to the associated increase in moderate and severe hypoglycemia. Conclusion: Current recommendations for glycemic control in surgical patients are informed primarily by trials using intensive insulin therapy in critically ill patients. Further research is necessary to ascertain the optimal glycemic target for non-critically ill patients, to determine if subsets of patients may benefit from strict glycemic control, and to identify alternative methods for treating stress hyperglycemia and explaining the mechanisms by which it increases infectious risk.