Risk factors for surgical site infection after cardiac surgery: the role of endogenous flora

OBJECTIVE: The study's objective was to assess predictors of surgical site infection (SSI) after cardiac surgery and the relationship of perioperative nasal carriage of Staphylococcus species with the development of SSI. METHODS: Surveillance for infections was performed, and anterior nares cultures of patients who underwent cardiac surgery were obtained. Preoperative risk factors were analyzed, and staphylococcal isolates from nares and SSI were compared using pulsed-field gel electrophoresis. RESULTS: Twelve patients had 14 SSIs (5.7 infections/100 surgeries). Two risk factors were significantly associated with SSI: smoking (P = .002, confidence interval(95) 1.1-1.4, relative risk = 1.3) and increased body mass index (P = .003, confidence interval(95) 2.8-99.8, relative risk = 16.8). A total of 5 of 8 infected patients (62.5%) for whom nares cultures were available had identical strains in their nares and SSI. CONCLUSION: Smoking and body mass index were predictors of SSI. Approximately 2 of 3 infected patients for whom nares cultures were obtained had an SSI that was likely from an endogenous source.     

Postdischarge surveillance: the impact on surgical site infection incidence in a Brazilian university hospital

OBJECTIVE: This prospective cohort study was carried out in a surgical unit of a university hospital in Brazil. The purpose of the study was to determine the incidence of surgical site infection (SSI) in patients during hospitalization and after discharge from the hospital. METHOD: In a sample of 630 patients who underwent surgical procedures, association among diagnosis of SSI (in-hospital or postdischarge), class of the surgery (elective or emergency), hospitalization period, patient's clinical condition (American Society of Anesthesiologists [ASA] score), classification of surgical site, and duration of surgical procedure were verified. RESULTS: Fifty SSIs were diagnosed while the patients were still in the hospital, and 140 postdischarge. Hospitalization periods >5 days and worse clinical condition (ASA III) were associated with a higher SSI incidence. Classification of SSI was not correlated to the incidence of in-hospital SSI, except for clean surgeries. Surgical procedures of >5 hours duration were correlated to SSI during hospitalization, and procedures of >2 hours duration correlated to a postdischarge SSI. Most SSIs (73.7%) were diagnosed postdischarge. CONCLUSION: Results show a high incidence of postsurgical infection detected during postdischarge surveillance, which suggests the need for postdischarge follow-ups for surgical patients.     

Differences in surgical site infection between laparoscopic colon and rectal surgeries: sub-analysis of a multicenter randomized controlled trial (Japan-Multinational Trial Organization PREV 07-01)

Background

The incidence of surgical site infection (SSI) is reportedly lower in laparoscopic colorectal surgery than in open surgery, but data on the difference in SSI incidence between colon and rectal laparoscopic surgeries are limited.

Methods

The incidence and risk factors for SSI, and the effect of oral antibiotics in colon and rectal laparoscopic surgeries, were investigated as a sub-analysis of the JMTO-PREV-07-01 (a multicenter, randomized, controlled trial of oral/parenteral vs. parenteral antibiotic prophylaxis in elective laparoscopic colorectal surgery).

Results

A total of 582 elective laparoscopic colorectal resections, comprising 376 colon surgeries and 206 rectal surgeries, were registered. The incidence of SSI in rectal surgery was significantly higher than in colon surgery (14 vs. 8.2 %, P = 0.041). Although the incidence of incisional SSI was almost identical (7 %) between the surgeries, the incidence of organ/space SSI in rectal surgery was significantly higher than in colon surgery (6.3 vs. 1.1 %, P = 0.0006). The lack of oral antibiotics was significantly associated with the development of SSI in colon surgery. Male sex, stage IV cancer, and abdominoperineal resection were significantly associated with SSI in rectal surgery. The combination of oral and parenteral antibiotics significantly reduced the overall incidence of SSI in colon surgery (relative risk 0.41, 95 % confidence interval 0.19–0.86).

Conclusion

The incidence of SSI in laparoscopic rectal surgery was higher than in colon surgery because of the higher incidence of organ/space SSI in rectal surgery. The risk factors for SSIs and the effect of oral antibiotics differed between these two procedures.

     

Surgical site infections in ambulatory surgery: a 5-year experience

OBJECTIVES: To evaluate the ambulatory surgical site infection rate and risk factors associated with surgical site infection. METHODS: We conducted a case-control analysis of all ambulatory surgeries between January 1, 1993, and December 31, 1997. The frequency of surgical site infection per 100 surgeries was calculated. The odds ratio (OR) was estimated by using logistic regression analysis. SETTING: A 140-bed tertiary-care teaching hospital for adult patients with cancer. RESULTS: The study followed 1350 outpatient surgeries. Thirty-eight patients had a surgical site infection (rate per 100 surgeries: 2.8). The risk factors statistically associated with surgical site infection were postoperative antibiotics (OR = 7.5; 95% CI, 2.5-23.0), and surgical time >35 minutes (OR = 2.4; 95% CI, 1.1-5.5). CONCLUSIONS: The surgical site infection rate for same-day surgery at our hospital is within the limits reported in the literature and below the rates reported previously for inpatient surgeries at our hospital. Full review of medical records and microbiology reports at day 30 allowed us to identify infections that otherwise would have been missed. Postoperative antibiotics may increase the risk of infection.     

Incidence of Surgical Site Infections in General Surgery in Italy

Abstract Background: Epidemiological study to determine surgical site infection (SSI) rates in surgical patients in Italy using the National Nosocomial Infections Surveillance system (NNIS), to monitor current surgical antimicrobial prophylaxis, and to identify possible modifiable risk factors for SSI. Materials and Methods: Thirty-two general surgeries participated in the study. Main criteria for site inclusion were: > 20 operations per week and amoxycillin/clavulanate among prophylactic options. Each patient operated from April 1st to May 30th 2002 was surveyed until 30 days after the operation. SSI cumulative incidence rates and 95% confidence intervals (95%CI) were calculated. Results: During the study period, 3,066 surgical procedures were performed in 2,972 patients. A total of 158 SSI were diagnosed in 154 patients: 96 (62.3%) were at superficial incision, 23 (14.9%) were at deep incision and 35 (22.7%) were at organ-space site. Incidence of SSI every 100 operations was 5.2% (95% CI 4.4–6.0). Of the 2,437 operated patients with clean or elective clean/contaminated or contaminated surgical procedure, 2,105 (86.4%) received antimicrobial prophylaxis, mainly amoxicillin/clavulanate (28.3%) and ceftizoxime (11.4%). Pre-operative hospital stay ≥ 48 h, diabetes, obesity, and HIV/AIDS infection were statistically significantly associated with increased risk of SSI. Conclusions: The SSI rates found are comparable with European studies and can be a benchmark for national incidence data and for inter- and intra-hospital SSI rate comparisons. The preliminary results of this study were presented at the 14th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) – May 1–4, 2004. Clin Microbiol Infect 2004; 10 (suppl 3): abstr P1521.     

Delayed wound healing and postoperative surgical site infections in patients with rheumatoid arthritis treated with or without biological disease-modifying antirheumatic drugs

Biological disease-modifying antirheumatic drugs (bDMARDs) have become more popular for treating rheumatoid arthritis (RA). Whether or not bDMARDs increase the postoperative risk of surgical site infection (SSI) has remained controversial. We aimed to clarify the effects of bDMARDs on the outcomes of elective orthopedic surgery. We used multivariate logistic regression analysis to analyze risk factors for SSI and delayed wound healing among 227 patients with RA (mean age, 65.0 years; disease duration, 16.9 years) after 332 elective orthopedic surgeries. We also attempted to evaluate the effects of individual medications on infection. Rates of bDMARD and conventional synthetic DMARD (csDMARD) administration were 30.4 and 91.0 %, respectively. Risk factors for SSI were advanced age (odds ratio [OR], 1.11; P?=?0.045), prolonged surgery (OR, 1.02; P?=?0.03), and preoperative white blood cell count >10,000/μL (OR, 3.66; P?=?0.003). Those for delayed wound healing were advanced age (OR, 1.16; P?=?0.001), prolonged surgery (OR, 1.02; P?=?0.007), preoperative white blood cell count >10,000/μL (OR, 4.56; P?=?0.02), and foot surgery (OR, 6.60; P?=?0.001). Risk factors for SSI and medications did not significantly differ. No DMARDs were risk factors for any outcome examined. Biological DMARDs were not risk factors for postoperative SSI. Foot surgery was a risk factor for delayed wound healing.     

A prospective study of surgical site infections in a pediatric hospital in Mexico City

BACKGROUND: Pediatric surgical site infection (SSI) rates in the United States range from 2.5% to 4.4%. There is little data regarding their risk factors among children. We quantified SSI rates and identified risk factors of SSI in a tertiary care pediatric teaching hospital in Mexico City. METHODS: All neurosurgical, cardiovascular, and general surgical patients who underwent operation between Aug 1, 1998, and Jan 31, 1999, were followed-up daily during hospitalization. On postoperative day 30, a full review of microbiology reports and medical records was performed. Univariate and multivariate analyses were done to identify risk factors. RESULTS: Four hundred twenty-eight of 530 children completed follow-up. The overall SSI rate was 18.7%. Forty percent of SSI were superficial incisional, 21% were deep incisional, and 39% were organ/space infections. For clean, clean-contaminated, contaminated, and dirty procedures, SSI infection rates were 12.4%, 24.4%, 14.3%, and 32.4%, respectively. Open drains (OR = 2.3; 95% CI = 1.3-4.2; P <.005) and surgery that lasted 90 or more minutes (OR = 2.9; 95% CI = 1.6-5.1; P <.001) were associated with infection. CONCLUSIONS: Our rates are greater than comparable reported data among children. Duration of surgery and use of open drains were associated with SSI.     

Proposal for a sub-classification of hepato-biliary-pancreatic operations for surgical site infection surveillance following assessment of results of prospective multicenter data

Background

Surgical site infection (SSI) surveillance in Japan is based on the National Nosocomial Infection Surveillance system, which categorizes all hepato-biliary-pancreatic surgeries, except for cholecystectomy, into “BILI.” We evaluated differences among BILI procedures to determine the optimal subdivision for SSI surveillance.

Methods

We conducted multicenter SSI surveillance at 20 hospitals. BILI was subdivided into choledochectomy, pancreatoduodenectomy, hepatectomy, hepatectomy with biliary reconstruction, pancreatoduodenectomy with hepatectomy, distal pancreatectomy and total pancreatectomy to determine the optimal subdivision. The outcome of interest was SSI. Univariate and multivariate analyses were performed to determine the predictive significance of variables in each type of surgery.

Results

1,926 BILI cases were included in this study. SSI rates were 23.2 % for all BILI; for choledochectomy 23.6 %, pancreatoduodenectomy 39.3 %, hepatectomy 12.8 %, hepatectomy with biliary reconstruction 41.9 %, pancreatoduodenectomy with hepatectomy 27.3 %, distal pancreatectomy 31.8 %, and total pancreatectomy 20.0 %. SSI rates for hepatectomy were significantly lower than those for non-hepatectomy BILI. Risk factors for developing SSI with hepatectomy were drain placement and long operative duration, while for non-hepatectomy BILI, risk factors were use of intra-abdominal silk sutures, SSI risk index and long operative duration.

Conclusions

Hepatectomy and non-hepatectomy BILI differ with regard to the incidence of and risk factors for developing SSI. These surgeries should be assessed separately when conducting SSI surveillance.     

Effects of subcutaneous drain for the prevention of incisional SSI in high-risk patients undergoing colorectal surgery

Introduction  

We have previously demonstrated that the risk of incisional surgical site infection (SSI) increases with obesity and that the most useful predictor of incisional SSI is the thickness of subcutaneous fat. Based on this finding, we have recently attempted a closure technique in surgery for the obese in which a subcutaneous drain is inserted for the prevention of incisional SSI. The aim of this study was to assess the utility of a subcutaneous drain for preventing incisional SSI in patients undergoing colorectal surgery who are at high risk for incisional SSI.     

The effect of increasing age on the risk of surgical site infection

BACKGROUND: An increasing number of older persons undergo surgery, but the relationship between increasing age and risk of surgical site infection (SSI) has not been established. The objective of the present study was to determine the relationship between increasing age and risk of SSI. METHODS: The present cohort study included patients who underwent surgery between February 1991 and July 2002. Patients >17 years of age were divided randomly into derivation and validation cohorts. The study was conducted at 11 hospitals. SSIs were prospectively identified by use of Centers for Disease Control and Prevention criteria. RESULTS: The study included 144,485 consecutive surgical patients and 1684 SSIs (rate of SSI, 1.2%). There were 72,139 procedures and 873 SSIs in the derivation cohort. Adjusted analyses revealed a significant relationship between age and risk of SSI (P=.006). Risk of SSI increased by 1.1%/year between ages 17 and 65 years (P=.002). At age >/=65 years, risk of SSI decreased by 1.2% for each additional year (P=.008). There were 72,334 procedures and 811 SSIs in the validation cohort. The relationship between age and risk of SSI was similar in the validation cohort. CONCLUSIONS: Increasing age independently predicted an increased risk of SSI until age 65 years. At ages >/=65 years, increasing age independently predicted a decreased risk of SSI.     

Risk factors for surgical site infection following spinal surgery in Saudi Arabia: A retrospective case–control study

Surgical site infections (SSIs) are common complications after spinal surgery that result in increased morbidity, mortality, and healthcare costs. It was estimated that SSIs after spinal surgery resulted in a 4-fold increase in health care costs. The reported SSI rate following spinal surgery remains highly variable between approximately 0.5% and 18%. In this study, we aimed to estimate the SSI rate and identify possible risk factors for SSI after spinal surgery in our Saudi patient population.We conducted a single-center, retrospective case–control study in Saudi Arabia that included patients who developed SSIs, while the controls were all consecutive patients who underwent spinal surgery between January 2014 and December 2016. We extracted data on patient characteristics, anthropometric measurements, preoperative laboratory investigations, preoperative infection prevention measures, intraoperative measures, comorbidities, and postoperative care.We included 201 consecutive patients in our study; their median age was 56.9 years, and 51.2% were men. Only 4% (n = 8) of these patients developed SSIs postoperatively. Postoperative SSIs were significantly associated with longer postoperative hospital stays, hypertension, higher American Society of Anesthesia (ASA) scores, longer procedure durations, and the use of a greater number of blood transfusion units.This study revealed a low SSI rate following spinal surgery. We identified a history of hypertension, prolonged hospitalization, longer operative time, blood transfusion, and higher ASA score as risk factors for SSI in spine surgery in our population. As our findings are from a single institute, we believe that a national research collaboration among multiple disciplines should be performed to provide better estimates of SSI risk factors in our patient population.     

Risk factors for surgical site infection following spinal surgery: A meta-analysis

Study design:A meta-analysis.Background:We performed a meta-analysis to explore risk factors of surgical site infection (SSI) following spinal surgery.Methods:An extensive search of literature was performed in English database of PubMed, Embase, and Cochrane Library and Chinese database of CNKI and WANFANG (up to October 2020). We collected factors including demographic data and surgical factor. Data analysis was conducted with RevMan 5.3 and STATA 12.0.Results:Totally, 26 studies were included in the final analysis. In our study, the rate of SSI after spinal surgery was 2.9% (1222 of 41,624). Our data also showed that fusion approach (anterior vs posterior; anterior vs combined), osteotomy, transfusion, a history of diabetes and surgery, hypertension, surgical location (cervical vs thoracic; lumbar vs thoracic), osteoporosis and the number of fusion levels were associated with SSI after spinal surgery. However, age, sex, a history of smoking, body mass index, fusion approach (posterior vs combined), surgical location (cervical vs lumbar), duration of surgery, blood loss, using steroid, dural tear and albumin were not associated with development of SSI.Conclusions:In our study, many factors were associated with increased risk of SSI after spinal surgery. We hope this article can provide a reference for spinal surgeons to prevent SSI after spinal surgery.     

Systematic review on efficacy of preventive measures for surgical site infection by multiple-drug resistant gram-negative bacilli

BackgroundThere are no specific recommendations for prevention of surgical site infection (SSI) caused by multidrug resistant Gram-negative bacilli (MDR-GNB). Our objective was to systematically review the literature evaluating the efficacy and safety of measures specifically designed to prevent MDR-GNB SSI.MethodsWe searched MEDLINE, EMBASE, CINAHL and LILACS databases up to February 18, 2020. Randomized trials and observational cohort studies evaluating the efficacy of preventive measures against MDR-GNB SSI in adult surgical patients were eligible. We evaluated methodological quality of studies and general quality of evidence using Newcastle-Ottawa scale, Cochrane ROBINS-I and GRADE method. Random-effects meta-analyses were performed using Review Manager V.5.3 software.ResultsA total of 10,663 titles by searching databases were identified. Two retrospective observational studies, comparing surgical antibiotic prophylaxis (SAP) with or without aminoglycoside in renal transplantation recipients, and one non-randomized prospective study, evaluating ertapenem vs. cephalosporin plus metronidazole for SAP in extended spectrum beta-lactamase producing Enterobacteriales carriers undergoing colon surgery, were included. Risk of bias was high in all studies. Meta-analysis was performed for the renal transplantation studies, with 854 patients included. Combined relative risk (RR) for MDR GNB SSI was 0.57 (95%CI: 0.25-1.34), favoring SAP with aminoglycoside (GRADE: moderate).ConclusionsThere are no sufficient data supporting specific measures against MDR-GNB SSI. Prospective, randomized studies are necessary to assess the efficacy and safety of SAP with aminoglycoside for MDR-GNB SSI prevention among renal transplantation recipients and other populations. PROSPERO 2018 CRD42018100845.     

The Effect of Surgical Site Infection on Older Operative Patients

OBJECTIVES: To determine the effect of surgical site infection (SSI) on mortality, duration of hospitalization, and hospital cost in older operative patients.
DESIGN: Retrospective matched-outcomes study.
SETTING: Eight hospitals, including Duke University Medical Center, and seven community hospitals.
PARTICIPANTS: Patients aged 65 and older undergoing surgery from 1991 to 2003. Cases were defined as patients who developed deep incisional or organ or space SSI; controls were operative patients who did not develop SSI. Controls were frequency matched to cases according to type and year of operative procedure and to hospital in a 1:1 ratio.
MEASUREMENTS: Mortality, duration of hospitalization (including re-admissions), and hospital charges for the 90 days after surgery.
RESULTS: One thousand three hundred thirty-seven patients were enrolled in the study: 561 cases with SSI and 576 controls without SSI. In cases, the most common SSI pathogen was Staphylococcus aureus (n=275, 51.6%). Of S. aureus isolates, 58.2% were methicillin resistant. One hundred sixteen subjects died within 90 days of surgery (8.6%). In multivariable analysis, SSI was associated with greater mortality risk (odds ratio (OR)=3.51, 95% confidence interval (CI)=2.20–5.59), 2.9 times longer postoperative hospitalization (95% CI=2.61–3.13), and 1.9 times greater hospital charges (95% CI=1.78–2.10).
CONCLUSION: In elderly operative patients, SSI was associated with almost 4 times greater mortality, a mean attributable duration of hospitalization after surgery of 15.7 days (95% CI=13.9–17.6) and mean attributable hospital charges of $43,970 (95% CI=$31,881–56,060).     

Determinants of surgical site infection after breast biopsy

BACKGROUND: Surgical site infections (SSI) following clean and clean-contaminated ambulatory surgery at Bon Secours Cottage Health Services are monitored utilizing a postdischarge surveillance form in addition to traditional surveillance. From January 2000 to December 2002, the clean procedure SSI rate was 0.73% (31/4266) versus 1.58% (15/950) for breast biopsy, P = .04. A case-control study was performed to identify risk factors for infection. METHODS: A case patient was identified as any patient having an ambulatory breast biopsy from January 2000 to December 2002 with SSI identified by the Centers for Disease Control and Prevention (CDC) definition of nosocomial infection. For each case patient, 3 randomly selected control patients were matched by date and procedure. RESULTS: Factors significantly associated with the development of SSI were duration of surgery (case mean, 71.7 minutes vs control mean, 34.7 minutes, P < .01) and presence of surgical drains (26.7% of cases vs 6.7% of controls, P = .04). Factors determined not to be associated with SSI were obesity (P = .88) and preoperative needle localization (P = .88). CONCLUSIONS: We conclude that there is a significant difference between the breast biopsy infection rate and the clean procedure infection rate in ambulatory surgery. Duration of surgery and presence of surgical drains were associated with increased infection rate.     

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.     

Infliximab administration prior to surgery does not increase surgical site infections in patients with ulcerative colitis

Purpose

The high incidence of infectious complications in ulcerative colitis (UC) is generally recognized to be due to several factors related to a compromised host. In our previous study, a high dose of corticosteroid was shown to be a risk factor for surgical site infection (SSI). Recently, infliximab (IFX) has been used for refractory UC. In this study, the effect of IFX on the occurrence of infectious postoperative complications for UC was evaluated, because it remains controversial.

Method

A total of 196 UC patients who underwent laparotomy between January 2010 and September 2012 were included. Possible factors related to complications were analyzed to identify significant predictors.

Results

Twenty-two patients had IFX before surgery. The overall incidence of SSI was 47/196 (24.0 %). The incidence of infections, including SSI and other infections, was 69/196 (35.2 %). On multivariate analysis, national nosocomial infection surveillance (NNIS) risk index ≥2 (p<0.01) and preoperative prednisolone dose ≥0.2 mg/kg/day (p?=?0.01) were identified as independent risk factors for overall SSI; NNIS risk index ≥2 (p <0.01) and duration from onset of UC ≥6.3 years (p?=?0.045) were identified as independent risk factors for incisional SSI; contaminated wound class (p <0.01), preoperative hospital stay ≥6 days (p?=?0.048), severe/fulminant disease activity (p?=?0.04), and pancolitis (p?=?0.02) were identified as independent risk factors for organ/space SSI; and contaminated wound (p?<?0.01), severe/fulminant disease activity (p?=?0.02), and age at surgery ≥43 years (p?=?0.047) were identified as independent risk factors for total infectious complications.

Conclusion

IFX administration was not associated with infectious complications for UC surgery.     

Risk factors for surgical site infections in older people

OBJECTIVES: To identify risk factors for surgical site infection (SSI) in older people and to test a priori hypotheses regarding particular variables and SSI risk. DESIGN: Case-control study. SETTING: Duke University Medical Center and seven community hospitals in North Carolina and Virginia. PARTICIPANTS: Elderly patients (> or =65) who underwent surgery between 1991 and 2002 at the study hospitals. Cases were elderly patients with SSI; controls were elderly operative patients without SSI. Infection control practitioners prospectively identified patients. MEASUREMENTS: Data were collected retrospectively. Case patients who developed SSI were compared with control patients who did not develop SSI. RESULTS: Five hundred sixty-nine SSI cases were identified, and 589 uninfected controls were selected. In multivariate analysis, independent predictors of SSI included obesity (odds ratio (OR)=1.77, 95% confidence interval (CI)=1.34-2.32), chronic obstructive pulmonary disease (COPD) (OR=1.66, 95% CI=1.17-2.34), and a wound class classified as contaminated or dirty (OR=1.65, 95% CI=1.01-2.72). Having private insurance was associated with lower risk (OR=0.29, 95% CI=0.12-0.68). CONCLUSION: This study identified several independent predictors of SSI in older people, including comorbid conditions (COPD and obesity), perioperative variables (wound class), and socioeconomic factors (private insurance, which was associated with lower risk). The results from this study can be used to design and implement interventions for SSI prevention in high-risk older people.     

Local application of gentamicin collagen implants in the prophylaxis of surgical site infections following gastrointestinal surgery: a review of clinical experience

Background  

Surgical site infection (SSI) is a common type of healthcare-associated infection in gastrointestinal (GI) surgical procedures, which often has major consequences for patient recovery and increased healthcare costs due to prolonged hospital stay. This article provides an overview of the efficacy and safety of prophylactic application of resorbable gentamicin-containing collagen implants (GCI) in the prevention of SSI following high-risk GI surgical procedures.     

Standardized incidence rates of surgical site infection: a multicenter study in Thailand

BACKGROUND: No previous multicenter data regarding the incidence of surgical site infection (SSI) are available in Thailand. The magnitude of the problem resulting from SSI at the national level could not be assessed. The purpose of this study was to estimate the incidence of SSI in 9 hospitals, together with patterns of surgical antibiotic prophylaxis, risk factors for SSI, and common causative pathogens. METHODS: A prospective data collection among patients undergoing surgery in 9 hospitals in Thailand was conducted. The National Nosocomial Infection Surveillance (NNIS) system criteria and method were used for identifying and diagnosing SSI. The SSI rates were benchmarked with the NNIS report by means of indirect standardization and reported in terms of standardized infection ratio (SIR). Antibiotic prophylaxis was categorized into preoperative, intraoperative, and postoperative. Risk factors for SSI were evaluated using multiple logistic regression models. RESULTS: From July 1, 2003, to February 29, 2004, the study included 8764 patients with 8854 major operations and identified 127 SSIs, yielding an SSI rate of 1.4 infections/100 operations and a corresponding SIR of 0.6 (95% CI: 0.5-0.8). Of these, 35 SSIs (27.6%) were detected postdischarge. The 3 most common operative procedures were cesarean section, appendectomy, and hysterectomy. The 3 most common pathogens isolated were Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa, which accounted for 15.3%, 8.5%, and 6.8% of infections, respectively. The 3 most common antibiotics used for prophylaxis were ampicillin/amoxicillin, cefazolin, and gentamicin. The proportion of types of antibiotic prophylaxis administered were 51.6% preoperative, 24.3% intraoperative, and 24.1% postoperative. Factors significantly associated with SSI were high degree of wound contamination, prolonged preoperative hospital stay, emergency operation, and prolonged duration of operation. CONCLUSION: Overall SSI rates were less than the average NNIS rates. The causative pathogens of SSI were different from those of other reports. There was a crucial proportion of operations that did not comply with the antibiotic guidelines. The risk factors for SSI identified in this study were consistent with most other reports.