{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T04:52:25Z","timestamp":1781844745216,"version":"3.54.5"},"reference-count":48,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Enhanced Recovery After Surgery (ERAS\u00ae) is a multimodal perioperative framework designed to mitigate the physiological stress response to major surgery. While ERAS protocols consistently reduce length of hospital stay, overall complication rates, and healthcare costs compared to conventional care, their specific impact on surgical site infections (SSIs) remains poorly defined. This review explores the potential synergistic benefits of integrating ERAS protocols with established infection prevention bundles. By evaluating the current clinical evidence, we analyze how the co-implementation of these two evidence-based strategies can collectively reduce the incidence of SSIs.<\/jats:p>","DOI":"10.3390\/antibiotics15060602","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:49:01Z","timestamp":1781570941000},"page":"602","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Enhanced Recovery After Surgery (ERAS) and Surgical Site Infections (SSIs)"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6338-0114","authenticated-orcid":false,"given":"Marco","family":"Catarci","sequence":"first","affiliation":[{"name":"General Surgery Unit, Sandro Pertini Hospital, ASL Roma 2, Via dei Monti Tiburtini, 385, 00157 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2475-3475","authenticated-orcid":false,"given":"Luca","family":"Pellegrino","sequence":"additional","affiliation":[{"name":"Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, 10060 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0617-6800","authenticated-orcid":false,"given":"Paolo","family":"Ciano","sequence":"additional","affiliation":[{"name":"General Surgery Unit, Sandro Pertini Hospital, ASL Roma 2, Via dei Monti Tiburtini, 385, 00157 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Salomone","sequence":"additional","affiliation":[{"name":"Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, 10060 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2367-7797","authenticated-orcid":false,"given":"Michele","family":"Benedetti","sequence":"additional","affiliation":[{"name":"General Surgery Unit, Sandro Pertini Hospital, ASL Roma 2, Via dei Monti Tiburtini, 385, 00157 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felice","family":"Borghi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, 10060 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1097\/SLA.0b013e31817f2c1a","article-title":"Evidence-based surgical care and the evolution of fast-track surgery","volume":"248","author":"Kehlet","year":"2008","journal-title":"Ann. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1001\/jamasurg.2017.0904","article-title":"Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017","volume":"152","author":"Umscheid","year":"2017","journal-title":"JAMA Surg."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Sanger, P.C., Hartzler, A., Han, S.M., Leas, B., Stone, E.C., Kelz, R.R., Reinke, C.E., Morgan, S., Solomkin, J.S., and Mazuski, J.E. (2014). Patient perspectives on post-discharge surgical site infections: Towards a patient-centered mobile health solution. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0114016"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1007\/s00268-013-2416-8","article-title":"Enhanced recovery program in colorectal surgery: A meta-analysis of randomized controlled trials","volume":"38","author":"Greco","year":"2014","journal-title":"World J. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1001\/archsurg.2010.309","article-title":"Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery","volume":"146","author":"Gustafsson","year":"2011","journal-title":"Arch. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1097\/SLA.0000000000002566","article-title":"Adherence to enhanced recovery protocols in NSQIP and association with colectomy outcomes","volume":"269","author":"Berian","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1001\/jamasurg.2019.0995","article-title":"Association between Use of Enhanced Recovery after Surgery Protocol and Postoperative Complications in Colorectal Surgery: The Postoperative Outcomes Within Enhanced Recovery after Surgery Protocol (POWER) Study","volume":"154","author":"Aldecoa","year":"2019","journal-title":"JAMA Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"110752","DOI":"10.1016\/j.jclinane.2022.110752","article-title":"Association between use of enhanced recovery after surgery protocols and postoperative complications in colorectal surgery in Europe: The EuroPOWER international observational study","volume":"80","author":"Cecconi","year":"2022","journal-title":"J. Clin. Anesth."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e24","DOI":"10.1097\/IA9.0000000000000024","article-title":"High adherence to enhanced recovery pathway independently reduces major morbidity and mortality rates after colorectal surgery: A reappraisal of the iCral2 and iCral3 multicenter prospective studies","volume":"43","author":"Catarci","year":"2023","journal-title":"G. Chir."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1097\/DCR.0000000000003655","article-title":"Enhanced Recovery Independently Lowers Failure to Rescue After Colorectal Surgery","volume":"68","author":"Catarci","year":"2025","journal-title":"Dis. Colon. Rectum."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"110379","DOI":"10.1016\/j.ejso.2025.110379","article-title":"Enhanced recovery and survival after elective surgery for colorectal cancer\u2014Propensity score weighting analysis of 2865 prospective patients","volume":"51","author":"Catarci","year":"2025","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"9015854","DOI":"10.1155\/2017\/9015854","article-title":"Influence of Enhanced Recovery Pathway on Surgical Site Infection after Colonic Surgery","volume":"2017","author":"Gronnier","year":"2017","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1136\/bmjqs-2023-016594","article-title":"Implementation of an enhanced recovery after surgery protocol for colorectal cancer in a regional hospital network supported by audit and feedback: A stepped wedge, cluster randomised trial","volume":"33","author":"Pagano","year":"2024","journal-title":"BMJ Qual. Saf."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1097\/SLA.0000000000001703","article-title":"Impact of Enhanced Recovery After Surgery and Fast Track Surgery Pathways on Healthcare-associated Infections: Results from a Systematic Review and Meta-analysis","volume":"265","author":"Grant","year":"2017","journal-title":"Ann. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1007\/s10388-020-00718-9","article-title":"Enhanced recovery pathways vs standard care pathways in esophageal cancer surgery: Systematic review and meta-analysis","volume":"17","author":"Triantafyllou","year":"2020","journal-title":"Esophagus"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.3748\/wjg.v24.i15.1666","article-title":"Impact of enhanced recovery after surgery programs on pancreatic surgery: A meta-analysis","volume":"24","author":"Ji","year":"2018","journal-title":"World J. Gastroenterol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e11728","DOI":"10.1097\/MD.0000000000011728","article-title":"Surgical site infections after pancreatic surgery in the era of enhanced recovery protocols","volume":"97","author":"Joliat","year":"2018","journal-title":"Medicine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"E542","DOI":"10.1503\/cjs.006720","article-title":"Return on investment of the Enhanced Recovery After Surgery (ERAS) multiguideline, multisite implementation in Alberta, Canada","volume":"63","author":"Thanh","year":"2020","journal-title":"Can. J. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"24055","DOI":"10.1038\/s41598-024-74389-2","article-title":"Impact of enhanced recovery after surgery (ERAS) on surgical site infection and postoperative recovery outcomes: A retrospective study of 1276 cases","volume":"14","author":"Wang","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_20","first-page":"e49448","article-title":"Enhanced Recovery After Surgery (ERAS) in Saudi Arabian Surgical Practice: A Comprehensive Analysis of Surgical Outcomes, Patient Satisfaction, and Cost-Effectiveness","volume":"15","author":"Aleid","year":"2023","journal-title":"Cureus"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"105315","DOI":"10.1016\/j.ijnurstu.2025.105315","article-title":"Effect of Enhanced Recovery After Surgery programs on surgical site infection and 30-day readmission in patients undergoing gastro-intestinal procedures: An umbrella review","volume":"175","author":"Gillespie","year":"2026","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"4171","DOI":"10.1007\/s11695-025-08175-y","article-title":"Enhanced Recovery After Surgery Reduces Complications and Length of Stay in Metabolic and Bariatric Surgery: A 1,800-Patient Middle Eastern Study","volume":"35","author":"Zhan","year":"2025","journal-title":"Obes. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1089\/sur.2024.046","article-title":"The Effect of Enhanced Recovery After Surgery Protocol on Surgical Site Infections in Liver Transplantation","volume":"25","author":"Kara","year":"2024","journal-title":"Surg. Infect."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1016\/j.spinee.2024.05.008","article-title":"Evaluation of ERAS protocol implementation on complex spine surgery complications and length of stay: A single institution study","volume":"24","author":"Dragun","year":"2024","journal-title":"Spine J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1097\/SLA.0000000000006243","article-title":"Anatomic Lung Resection Outcomes After Implementation of a Universal Thoracic ERAS Protocol Across a Diverse Health Care System","volume":"279","author":"Dyas","year":"2024","journal-title":"Ann. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1007\/s00345-025-06131-0","article-title":"Benefits of enhanced recovery after surgery in robotic nephrectomy","volume":"44","author":"Schrock","year":"2025","journal-title":"World J. Urol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S2265","DOI":"10.4103\/jpbs.jpbs_920_25","article-title":"Impact of ERAS Protocol on Postoperative Recovery and Complications in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective Comparative Analysis","volume":"17","author":"Soni","year":"2025","journal-title":"J. Pharm. Bioallied Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1089\/sur.2024.112","article-title":"ERAS and Gastrointestinal Site Infections: Insights from a Comprehensive Systematic Review and Meta-Analysis","volume":"25","author":"Wu","year":"2024","journal-title":"Surg. Infect."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1089\/lap.2023.0036","article-title":"The Application of Enhanced Recovery After Surgery for Gastrectomy and Colorectal Resection: A Systematic Review and Meta-Analysis","volume":"33","author":"Feng","year":"2023","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Liu, W., He, L., Yin, C., and Gong, G. (2025). Enhanced recovery after gastrectomy: Updated Meta-analysis of 27 randomized trials (2018\u20132025). BMC Surg., 26.","DOI":"10.1186\/s12893-025-03399-2"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s13037-024-00425-9","article-title":"Impact of \u201cEnhanced Recovery After Surgery\u201d (ERAS) protocols vs. traditional perioperative care on patient outcomes after colorectal surgery: A systematic review","volume":"19","author":"Kannan","year":"2025","journal-title":"Patient Saf. Surg."},{"key":"ref_32","first-page":"103178","article-title":"Pharmacotherapeutic prophylaxis and post-operative outcomes within an Enhanced Recovery After Surgery (ERAS\u00ae) program: A randomized retrospective cohort study","volume":"73","author":"Parrish","year":"2021","journal-title":"Ann. Med. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/j.ajic.2018.11.004","article-title":"Infection prevention and enhanced recovery after surgery: A partnership for implementation of an evidence-based bundle to reduce colorectal surgical site infections","volume":"47","author":"Albert","year":"2019","journal-title":"Am. J. Infect. Control"},{"key":"ref_34","first-page":"e19624","article-title":"Enhanced Recovery After Surgery: Are Benefits Demonstrated in International Studies Replicable in Pakistan?","volume":"13","author":"Soomro","year":"2021","journal-title":"Cureus"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2769","DOI":"10.1007\/s00423-021-02266-x","article-title":"Improving postoperative outcome in rectal cancer surgery: Enhanced Recovery After Surgery in an era of increasing laparoscopic resection","volume":"406","author":"Bakker","year":"2021","journal-title":"Langenbeck\u2019s Arch. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1503\/cjs.015617","article-title":"Impact of sequential implementation of multimodal perioperative care pathways on colorectal surgical outcomes","volume":"62","author":"Choi","year":"2019","journal-title":"Can. J. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2667","DOI":"10.1007\/s11605-023-05803-9","article-title":"Comparison of Enhanced Recovery After Surgery (ERAS) Pathway Versus Standard Care in Patients Undergoing Elective Stoma Reversal Surgery\u2014A Randomized Controlled Trial","volume":"27","author":"Madan","year":"2023","journal-title":"J. Gastrointest. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1007\/s11605-021-05184-x","article-title":"Adapted ERAS Pathway Versus Standard Care in Patients Undergoing Emergency Surgery for Perforation Peritonitis-a Randomized Controlled Trial","volume":"26","author":"Pranavi","year":"2022","journal-title":"J. Gastrointest. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e92","DOI":"10.1055\/s-0041-1725156","article-title":"Enhanced Recovery After Surgery Protocol in Emergency Laparotomy: A Randomized Control Study","volume":"7","author":"Sharma","year":"2021","journal-title":"Surg. J."},{"key":"ref_40","first-page":"e35760","article-title":"The Application of Enhanced Recovery After Surgery Protocols in Patients with Perforated Duodenal Ulcer","volume":"15","author":"Pathrikar","year":"2023","journal-title":"Cureus"},{"key":"ref_41","first-page":"e45349","article-title":"Impact of Tailored-Enhanced Recovery After Surgery Versus Conventional Care in Patients of Gastro-Duodenal Perforation: A Pilot Randomized Control Trial","volume":"15","author":"Tandup","year":"2023","journal-title":"Cureus"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1186\/s13017-025-00639-x","article-title":"Enhanced recovery after surgery versus conventional approach in peptic perforation\u2014A Randomized Controlled Trial\u2014\u201cERASE trial\u201d","volume":"20","author":"Mishra","year":"2025","journal-title":"World J. Emerg. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1002\/wjs.12234","article-title":"Fast-track recovery after surgery for perforated peptic ulcer safely shortens hospital stay: A systematic review and meta-analysis of six randomized controlled trials and 356 patients","volume":"48","author":"Zeyara","year":"2024","journal-title":"World J. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"491","DOI":"10.26574\/maedica.2025.20.3.491","article-title":"Comparison Between Conventional and Enhanced Recovery After Surgery (ERAS) Protocol in Cases of Emergency Laparotomy","volume":"20","author":"Pawar","year":"2025","journal-title":"Maedica"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"115975","DOI":"10.1016\/j.amjsurg.2024.115975","article-title":"Implementation of modified enhanced recovery after surgery (ERAS) following surgery for abdominal trauma; Assessment of feasibility and outcomes: A randomized controlled trial (RCT)","volume":"238","author":"Jain","year":"2024","journal-title":"Am. J. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e276","DOI":"10.1016\/S1473-3099(16)30398-X","article-title":"New WHO recommendations on preoperative measures for surgical site infection prevention: An evidence-based global perspective","volume":"16","author":"Allegranzi","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_47","unstructured":"National Institute for Health and Care Excellence (NICE) (2026, April 30). Surgical Site Infections: Prevention and Treatment. (NICE Guideline NG125). Available online: https:\/\/www.nice.org.uk\/guidance\/ng125\/resources\/surgical-site-infections-prevention-and-treatment-pdf-66141660564421."},{"key":"ref_48","first-page":"501990","article-title":"Beyond compliance: Patient risk, ERAS adherence, and postoperative outcomes through explainable machine learning","volume":"73","author":"Espinosa","year":"2026","journal-title":"Rev. Esp. Anestesiol. Reanim."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/6\/602\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T04:20:18Z","timestamp":1781842818000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/6\/602"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,12]]},"references-count":48,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["antibiotics15060602"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics15060602","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,12]]}}}