Impact of antibiotic prophylaxis on wound infection after cesarean section in a situation of expected higher risk

BACKGROUND: To measure rates of incisional surgical site infection (ISSI) after cesarean section (CS) and to assess risks for infection. METHODS: Prospective surveillance for ISSI at a 540-bed hospital in Saudi Arabia by using Centers for Disease Control and Prevention definitions for infection and the National Nosocomial Infections Surveillance (NNIS) system risk index. RESULTS: Seven hundred thirty-five CSs were studied from September 1998 to July 1999; 72% were emergency procedures, despite a 95% rate of antenatal care. The overall ISSI rate was 2.8% (95% confidence interval [CI], 1.7%-4.3%). The rate for NNIS risk category 0 was 2.4% (95% CI, 1.3%-4.2%; n = 536) and for category 1 was 4.1% (95% CI, 1.8%-8.6%; n = 170). In the multivariate analysis, the only independent risks for ISSI were duration of surgery (OR = 1.01; 95% CI, 1.00-1.03; P =.02) and no antibiotic prophylaxis (OR = 3.09; 95% CI, 1.10-9.11; P =.04). Antibiotic prophylaxis was inconsistently administered among both emergency and elective CS. Infection control procedures were inadequate in the obstetric suite operating room. CONCLUSIONS: Despite deficient infection control practices in the setting described, ISSI rates after CS were judged "acceptable" compared with NNIS benchmark rates. This was attributed to prescribing antibiotic prophylaxis for patients at low risk as well as high risk of infection.     

Risk of parenterally transmitted hepatitis following exposure to surgery or other invasive procedures: results from the hepatitis surveillance system in Italy

BACKGROUND/AIMS: To evaluate the strength of association between parenterally transmitted viral hepatitis and specific types of invasive procedures. METHODS: Data from the surveillance system for type-specific acute viral hepatitis (SEIEVA) during the period 1994-1999 were used. The association of acute hepatitis B virus (HBV) and hepatitis C virus (HCV) infection with the potential risk factors (odds ratios (OR)) was estimated comparing 3120 hepatitis B and 1023 hepatitis C cases with 7158 hepatitis A cases, used as controls, by multiple logistic regression analysis. RESULTS: Most procedures resulted in being associated with the risk of acquiring acute HBV or HCV. The strongest associations were: for HBV infection, abdominal surgery (adjusted OR = 3.9; 95% confidence intervals (CI) = 2.0-7.5), oral surgery (OR = 2.7; 95% CI = 1.6-4.5) and gynaecological surgery (OR = 2.6; 95% CI = 1.2-5.5); for HCV infection, obstetric/gynaecological interventions (OR = 12.1; 95% CI = 5.6-26.3), abdominal surgery (OR = 7.0; 95% CI = 3.2-14.9) and ophthalmological surgery (OR = 5.2; 95% CI = 1.1-23.2). Biopsy and/or endoscopy were associated with HCV, but not with HBV infection. CONCLUSIONS: Invasive procedures represent an important mode of HBV and HCV transmission. Since a large proportion of the adult general population is exposed to these procedures and an effective HCV vaccine is not yet available, non-immunological means of controlling iatrogenic modes of transmission are extremely important.     

Risk factors for pneumonia and other lower respiratory tract infections in elderly residents of long-term care facilities.

BACKGROUND: Little is known about the risk factors, outcome, and impact of pneumonia and other lower respiratory tract infections (LRTIs) in residents of long-term care facilities. OBJECTIVE: To determine the risk factors and the effect of these infections on functional status and clinical course. METHODS: Active surveillance for these infections was conducted for 475 residents in 5 nursing homes from July 1, 1993, through June 30, 1996. Information regarding potential risk factors for these infections, functional status, transfers to hospital, and death was also obtained. RESULTS: Two hundred seventy-two episodes of pneumonia and other LRTIs occurred in 170 residents during 228 757 days of surveillance for an incidence of 1.2 episodes per 1000 resident-days. Multivariable analysis revealed that older age (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.1-2.6 per 10-year interval; P = .01), male sex (OR, 1.9; 95% CI, 1.1-3.5; P = .03), swallowing difficulty (OR, 2.0; 95% CI, 1.2-3.3; P = .01), and the inability to take oral medications (OR, 8.3; 95% CI, 1.4-50.3; P = .02) were significant risk factors for pneumonia; receipt of influenza vaccine (OR, 0.4; 95% CI, 0.3-0.5; P = .01) was protective. Age (OR, 1.6 [95% CI, 1.0-2.5] per 10-year interval; P = .05) and immobility (OR, 2.6; 95% CI, 1.8-3.8; P = .01) were significant risk factors for other LRTIs, and influenza vaccination was protective (OR, 0.3; 95% CI, 0.2-0.4; P = .01). Residents with pneumonia (OR, 0.7; 95% CI, 0.3-1.4; P = .31) or with other LRTIs (OR, 0.5; 95% CI, 0.2-1.1; P = .43) were no more likely to have a deterioration in functional status than individuals in whom infection did not develop. CONCLUSIONS: Swallowing difficulty and lack of influenza vaccination are important, modifiable risks for pneumonia and other LRTIs in elderly residents of long-term care facilities. Our findings challenge the commonly held belief that pneumonia leads to long-term decline in functional status in this population.     

Risk factors for hepatitis C virus infection in United States blood donors. NHLBI Retrovirus Epidemiology Donor Study (REDS)

Injection drug use (IDU) is a known risk factor for hepatitis C virus (HCV) infection, but the strength of other parenteral and sexual risk factors is unclear. In 1997, we performed a case-control study of 2,316 HCV-seropositive blood donors and 2,316 seronegative donors matched on age, sex, race/ethnicity, blood center, and first-time versus repeat-donor status. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated using conditional logistic regression. Questionnaires were returned by 758 (33%) HCV(+) and 1,039 (45%) control subjects (P =.001). The final multivariate model included only the following independent HCV risk factors: IDU (OR = 49.6; 95% CI: 20.3-121.1), blood transfusion in non-IDU (OR = 10.9; 95% CI: 6.5-18.2), sex with an IDU (OR = 6.3; 95% CI: 3.3-12.0), having been in jail more than 3 days (OR = 2.9; 95% CI: 1.3-6.6), religious scarification (OR = 2.8; 95% CI: 1.2-7. 0), having been stuck or cut with a bloody object (OR = 2.1; 95% CI: 1.1-4.1), pierced ears or body parts (OR = 2.0; 95% CI: 1.1-3.7), and immunoglobulin injection (OR = 1.6; 95% CI: 1.0-2.6). Although drug inhalation and a high number of lifetime sex partners were significantly more common among HCV seropositives, they were not associated with HCV after controlling for IDU and other risk factors. IDU, blood transfusion among non-IDU, and sex with an IDU are strong risk factors for HCV among United States blood donors. Weaker associations with incarceration, religious scarification, being stuck or cut with a bloody object, pierced ears or body parts, and immunoglobulin injection must be interpreted with caution.     

肝母细胞瘤患儿及其母亲孕期特点回顾性分析

目的 探讨肝母细胞瘤发生的危险因素,包括婴儿出生以及孕产妇分娩相关的特征.方法 采用病例-对照研究设计,收集肝母细胞瘤患儿及其母亲的病历资料,用Logistic回归模型对婴儿特征指标、母亲怀孕与分娩有关指标进行多因素统计检验. 结果发生肝母细胞瘤风险中低出生体质量儿的比值比为26.0(95%可信区间为14.0～65.7).母亲≤20岁和≥30岁的比值比分别为1.5(95%可信区间为0.6～4.6)和2.6(95%可信区间为1.0～6.7).超重和肥胖母亲的比值比为3.2(95%可信区间为1.0～6.7).孕妇吸烟的比值比为2.9(95%可信区间为1.1～4.2),对>2岁及H{生体质量正常儿童影响较大. 结论肝母细胞瘤的发生与患儿出生体质量及孕妇超重、吸烟等因素有关,应重视围产期卫生保健.     

Risk factors for surgical site infections and other complications in elective surgery in patients with rheumatoid arthritis with special attention for anti-tumor necrosis factor: a large retrospective study

OBJECTIVE: To identify risk factors for surgical site infection (SSI) in patients with rheumatoid arthritis (RA) with special attention for anti-tumor necrosis factor (anti-TNF) treatment. METHODS: All patients with RA who had undergone elective orthopedic surgery since introduction of anti-TNF were included in a retrospective parallel-cohort study with a one-year followup. Primary endpoint was a SSI according to the 1992 Centers for Disease Control and Prevention criteria and/or antibiotic use. Cohort 1 did not use anti-TNF, cohort 2 used anti-TNF but had either stopped (2A) or continued anti-TNF preoperatively (2B), the cutoff point being set at 4 times the half-life time of the drug. Infection rates were compared between cohorts, and logistic regression analysis was performed to examine risk factors. RESULTS: In total, 1219 (768 patients) procedures were included, and crude infection risks were 4.0% (41/1023), 5.8% (6/104), and 8.7% (8/92) in cohorts 1, 2A, and 2B, respectively. Elbow surgery (OR 4.1, 95% CI 1.6-10.1), foot/ankle surgery (OR 3.2, 95% CI 1.6-6.5), and prior skin or wound infection (OR 13.8, 95% CI 5.2-36.7) were associated with increased risk of SSI, whereas duration of surgery (OR 0.42, 95% CI 0.23-0.78) and sulfasalazine use (OR 0.21, 95% CI 0.05-0.89) were associated with decreased risk. Perioperative use of anti-TNF was not significantly associated with an increase in SSI rates (OR 1.5, 95% CI 0.43-5.2). CONCLUSION: The most important risk factor for SSI is history of SSI or skin infection. Although our study was not powered to detect small differences in infection rates, perioperative continuation of anti-TNF does not seem to be an important risk factor for SSI.     

肝母细胞瘤患儿及其母亲孕期特点回顾性分析

目的 探讨肝母细胞瘤发生的危险因素,包括婴儿出生以及孕产妇分娩相关的特征.方法 采用病例-对照研究设计,收集肝母细胞瘤患儿及其母亲的病历资料,用Logistic回归模型对婴儿特征指标、母亲怀孕与分娩有关指标进行多因素统计检验. 结果发生肝母细胞瘤风险中低出生体质量儿的比值比为26.0(95%可信区间为14.0～65.7).母亲≤20岁和≥30岁的比值比分别为1.5(95%可信区间为0.6～4.6)和2.6(95%可信区间为1.0～6.7).超重和肥胖母亲的比值比为3.2(95%可信区间为1.0～6.7).孕妇吸烟的比值比为2.9(95%可信区间为1.1～4.2),对>2岁及H{生体质量正常儿童影响较大. 结论肝母细胞瘤的发生与患儿出生体质量及孕妇超重、吸烟等因素有关,应重视围产期卫生保健.     

肝母细胞瘤患儿及其母亲孕期特点回顾性分析

目的 探讨肝母细胞瘤发生的危险因素,包括婴儿出生以及孕产妇分娩相关的特征.方法 采用病例-对照研究设计,收集肝母细胞瘤患儿及其母亲的病历资料,用Logistic回归模型对婴儿特征指标、母亲怀孕与分娩有关指标进行多因素统计检验. 结果发生肝母细胞瘤风险中低出生体质量儿的比值比为26.0(95%可信区间为14.0～65.7).母亲≤20岁和≥30岁的比值比分别为1.5(95%可信区间为0.6～4.6)和2.6(95%可信区间为1.0～6.7).超重和肥胖母亲的比值比为3.2(95%可信区间为1.0～6.7).孕妇吸烟的比值比为2.9(95%可信区间为1.1～4.2),对>2岁及H{生体质量正常儿童影响较大. 结论肝母细胞瘤的发生与患儿出生体质量及孕妇超重、吸烟等因素有关,应重视围产期卫生保健.     

肝母细胞瘤患儿及其母亲孕期特点回顾性分析

目的 探讨肝母细胞瘤发生的危险因素,包括婴儿出生以及孕产妇分娩相关的特征.方法 采用病例-对照研究设计,收集肝母细胞瘤患儿及其母亲的病历资料,用Logistic回归模型对婴儿特征指标、母亲怀孕与分娩有关指标进行多因素统计检验. 结果发生肝母细胞瘤风险中低出生体质量儿的比值比为26.0(95%可信区间为14.0～65.7).母亲≤20岁和≥30岁的比值比分别为1.5(95%可信区间为0.6～4.6)和2.6(95%可信区间为1.0～6.7).超重和肥胖母亲的比值比为3.2(95%可信区间为1.0～6.7).孕妇吸烟的比值比为2.9(95%可信区间为1.1～4.2),对>2岁及H{生体质量正常儿童影响较大. 结论肝母细胞瘤的发生与患儿出生体质量及孕妇超重、吸烟等因素有关,应重视围产期卫生保健.     

肝母细胞瘤患儿及其母亲孕期特点回顾性分析

目的 探讨肝母细胞瘤发生的危险因素,包括婴儿出生以及孕产妇分娩相关的特征.方法 采用病例-对照研究设计,收集肝母细胞瘤患儿及其母亲的病历资料,用Logistic回归模型对婴儿特征指标、母亲怀孕与分娩有关指标进行多因素统计检验. 结果发生肝母细胞瘤风险中低出生体质量儿的比值比为26.0(95%可信区间为14.0～65.7).母亲≤20岁和≥30岁的比值比分别为1.5(95%可信区间为0.6～4.6)和2.6(95%可信区间为1.0～6.7).超重和肥胖母亲的比值比为3.2(95%可信区间为1.0～6.7).孕妇吸烟的比值比为2.9(95%可信区间为1.1～4.2),对>2岁及H{生体质量正常儿童影响较大. 结论肝母细胞瘤的发生与患儿出生体质量及孕妇超重、吸烟等因素有关,应重视围产期卫生保健.     

肝母细胞瘤患儿及其母亲孕期特点回顾性分析

目的 探讨肝母细胞瘤发生的危险因素,包括婴儿出生以及孕产妇分娩相关的特征.方法 采用病例-对照研究设计,收集肝母细胞瘤患儿及其母亲的病历资料,用Logistic回归模型对婴儿特征指标、母亲怀孕与分娩有关指标进行多因素统计检验. 结果发生肝母细胞瘤风险中低出生体质量儿的比值比为26.0(95%可信区间为14.0～65.7).母亲≤20岁和≥30岁的比值比分别为1.5(95%可信区间为0.6～4.6)和2.6(95%可信区间为1.0～6.7).超重和肥胖母亲的比值比为3.2(95%可信区间为1.0～6.7).孕妇吸烟的比值比为2.9(95%可信区间为1.1～4.2),对>2岁及H{生体质量正常儿童影响较大. 结论肝母细胞瘤的发生与患儿出生体质量及孕妇超重、吸烟等因素有关,应重视围产期卫生保健.     

肝母细胞瘤患儿及其母亲孕期特点回顾性分析

目的 探讨肝母细胞瘤发生的危险因素,包括婴儿出生以及孕产妇分娩相关的特征.方法 采用病例-对照研究设计,收集肝母细胞瘤患儿及其母亲的病历资料,用Logistic回归模型对婴儿特征指标、母亲怀孕与分娩有关指标进行多因素统计检验. 结果发生肝母细胞瘤风险中低出生体质量儿的比值比为26.0(95%可信区间为14.0～65.7).母亲≤20岁和≥30岁的比值比分别为1.5(95%可信区间为0.6～4.6)和2.6(95%可信区间为1.0～6.7).超重和肥胖母亲的比值比为3.2(95%可信区间为1.0～6.7).孕妇吸烟的比值比为2.9(95%可信区间为1.1～4.2),对>2岁及H{生体质量正常儿童影响较大. 结论肝母细胞瘤的发生与患儿出生体质量及孕妇超重、吸烟等因素有关,应重视围产期卫生保健.     

肝母细胞瘤患儿及其母亲孕期特点回顾性分析

目的 探讨肝母细胞瘤发生的危险因素,包括婴儿出生以及孕产妇分娩相关的特征.方法 采用病例-对照研究设计,收集肝母细胞瘤患儿及其母亲的病历资料,用Logistic回归模型对婴儿特征指标、母亲怀孕与分娩有关指标进行多因素统计检验. 结果发生肝母细胞瘤风险中低出生体质量儿的比值比为26.0(95%可信区间为14.0～65.7).母亲≤20岁和≥30岁的比值比分别为1.5(95%可信区间为0.6～4.6)和2.6(95%可信区间为1.0～6.7).超重和肥胖母亲的比值比为3.2(95%可信区间为1.0～6.7).孕妇吸烟的比值比为2.9(95%可信区间为1.1～4.2),对>2岁及H{生体质量正常儿童影响较大. 结论肝母细胞瘤的发生与患儿出生体质量及孕妇超重、吸烟等因素有关,应重视围产期卫生保健.     

肝母细胞瘤患儿及其母亲孕期特点回顾性分析

目的 探讨肝母细胞瘤发生的危险因素,包括婴儿出生以及孕产妇分娩相关的特征.方法 采用病例-对照研究设计,收集肝母细胞瘤患儿及其母亲的病历资料,用Logistic回归模型对婴儿特征指标、母亲怀孕与分娩有关指标进行多因素统计检验. 结果发生肝母细胞瘤风险中低出生体质量儿的比值比为26.0(95%可信区间为14.0～65.7).母亲≤20岁和≥30岁的比值比分别为1.5(95%可信区间为0.6～4.6)和2.6(95%可信区间为1.0～6.7).超重和肥胖母亲的比值比为3.2(95%可信区间为1.0～6.7).孕妇吸烟的比值比为2.9(95%可信区间为1.1～4.2),对>2岁及H{生体质量正常儿童影响较大. 结论肝母细胞瘤的发生与患儿出生体质量及孕妇超重、吸烟等因素有关,应重视围产期卫生保健.     

肝母细胞瘤患儿及其母亲孕期特点回顾性分析

目的 探讨肝母细胞瘤发生的危险因素,包括婴儿出生以及孕产妇分娩相关的特征.方法 采用病例-对照研究设计,收集肝母细胞瘤患儿及其母亲的病历资料,用Logistic回归模型对婴儿特征指标、母亲怀孕与分娩有关指标进行多因素统计检验. 结果发生肝母细胞瘤风险中低出生体质量儿的比值比为26.0(95%可信区间为14.0～65.7).母亲≤20岁和≥30岁的比值比分别为1.5(95%可信区间为0.6～4.6)和2.6(95%可信区间为1.0～6.7).超重和肥胖母亲的比值比为3.2(95%可信区间为1.0～6.7).孕妇吸烟的比值比为2.9(95%可信区间为1.1～4.2),对>2岁及H{生体质量正常儿童影响较大. 结论肝母细胞瘤的发生与患儿出生体质量及孕妇超重、吸烟等因素有关,应重视围产期卫生保健.     

肝母细胞瘤患儿及其母亲孕期特点回顾性分析

目的 探讨肝母细胞瘤发生的危险因素,包括婴儿出生以及孕产妇分娩相关的特征.方法 采用病例-对照研究设计,收集肝母细胞瘤患儿及其母亲的病历资料,用Logistic回归模型对婴儿特征指标、母亲怀孕与分娩有关指标进行多因素统计检验. 结果发生肝母细胞瘤风险中低出生体质量儿的比值比为26.0(95%可信区间为14.0～65.7).母亲≤20岁和≥30岁的比值比分别为1.5(95%可信区间为0.6～4.6)和2.6(95%可信区间为1.0～6.7).超重和肥胖母亲的比值比为3.2(95%可信区间为1.0～6.7).孕妇吸烟的比值比为2.9(95%可信区间为1.1～4.2),对>2岁及H{生体质量正常儿童影响较大. 结论肝母细胞瘤的发生与患儿出生体质量及孕妇超重、吸烟等因素有关,应重视围产期卫生保健.     

Predictive and protective factors associated with colorectal cancer in ulcerative colitis: A case-control study

BACKGROUND & AIMS: Predictive and protective factors associated with colorectal cancer in chronic ulcerative colitis are not well described. Surveillance colonoscopy and 5-aminosalicylic acid therapy may mitigate cancer risk, but there is debate because these variables have not been evaluated in the same study. The presence of postinflammatory pseudopolyps and use of other anti-inflammatory medications may be important variables that influence risk, but data are sparse. METHODS: Variables associated with colorectal cancer were registered in 188 patients with ulcerative colitis-related cancer and matched controls. Conditional logistic regression, adjusted for age at colitis diagnosis and colitis duration, identified a final set of variables independently associated with colorectal cancer. RESULTS: In the final multiple variable model, the most important factors associated with colorectal cancer were a history of pseudopolyps (OR, 2.5; 95% CI: 1.4-4.6), 1 or 2 surveillance colonoscopies (OR, 0.4; 95% CI: 0.2-0.7), smoking (OR, 0.5; 95% CI: 0.2-0.9) and use of corticosteroids (OR, 0.4; 95% CI: 0.2-0.8), aspirin (OR, 0.3; 95% CI: 0.1-0.8), nonsteroidal anti-inflammatory drugs (OR, 0.1; 95% CI: 0.03-0.5), and 5-aminosalicylic acid agents (OR, 0.4; 95% CI: 0.2-0.9), although the latter was not statistically significant after 5 years. Primary sclerosing cholangitis and immunosuppressive use were not statistically significant. CONCLUSIONS: These results suggest that, in a population matched for extent and duration of chronic ulcerative colitis, surveillance colonoscopy and use of anti-inflammatory medications may reduce the risk of colorectal cancer. A history of postinflammatory pseudopolyps appears to be a predictive factor for cancer.     

Surgical site infection in patients submitted to digestive surgery: risk prediction and the NNIS risk index

BACKGROUND: Some problems have been reported with the power of the National Nosocomial Infection Surveillance (NNIS) risk index to predict the risk of surgical site infections (SSI) for specific procedures. OBJECTIVES: To develop an alternative risk prediction index for SSI and to compare the performance with the NNIS index. METHODS: A prospective cohort study was carried out with all (609) patients submitted to digestive tract surgery in 2 general teaching hospitals in the city of S?o Paulo, Brazil, from August 2001 through March 2002. RESULTS: The final incidence rate of SSI was 24.5%; 149 cases of SSI were identified: 33 (22.1%) during hospitalization and 116 (77.9%) after discharge. Logistic multivariate analysis was used for construction of the model. Obesity, surgery risk, adjusted duration, and video laparoscopic surgery were statistically significant (P < .05) for all previous procedures. The performance of the NNIS model in this study showed a low predictive capacity for the occurrence of SSI as determined by the receiver operating characteristic (ROC) curve (0.627; 95% CI: 0.575-0.678) compared with the alternative model developed with this population (0.732; 95% CI: 0.685-0.779). CONCLUSION: The presence of obesity, adjusted duration, and surgery risk significantly increased the risk for SSI. The NNIS risk index was not significant for SSI in the sample studied, and laparoscopic access was associated with a significant reduction in the risk for SSI. Although the NNIS index is a well-known and simple index, other models depicting variables related to SSI with a better sensitivity and specificity can be developed. Additional studies are required to confirm our results.     

Surgical site infections: might a longer locally defined T time affect the benchmarking?

BACKGROUND: A local surgical site infection surveillance system (LS System) was established in 1998 at our teaching hospital. The aims of this article were to compare locally defined cut-points with the NNIS System T times, and to evaluate the effectiveness of different cut-points in identifying procedures at high risk for infection. METHODS: The LS System T times were compared to those reported by the NNIS System. Procedures and surgical site infections (SSIs) were stratified according to two infection risk index (IRI) scores calculated by using the two cut-points. The effectiveness of the two IRI scores in predicting SSIs was assessed by receiver operating characteristic (ROC) analysis. RESULTS: We have found a longer T time in three procedures categories compared to those reported by the NNIS System (GAST, OGIT, and XLAP). The LS System risk index predicted SSIs better than did the NNIS System risk index only in other digestive category, with areas under ROC curve: being, respectively of 71.1% (95% CI, 60.9, 81.3) and 63.1% (95% CI, 54.0, 72.2). CONCLUSIONS: The use of the NNIS System T time is suitable in our local SSI surveillance system because it does not significantly affect the benchmarking.