title: Risk factors for surgical site infections after pediatric cardiovascular surgery Risk Factors for Mediastinitis and Endocarditis after Cardiac Surgery Risk factors for surgical site infections in older people. Surgical site infections in a tertiary health care center: Prospective cohort study Surgical-site infection after cardiac surgery: incidence, microbiology, and risk factors. Risk factors for neurosurgical site infections: an 18-month prospective survey. Positive nasal culture of methicillin-resistant Staphylococcus aureus (MRSA) is a risk factor for surgical site infection in orthopedics Predictors of surgical site infections among patients undergoing major surgery at Bugando Medical Centre in Northwestern Tanzania Superficial and deep sternal wound infection after more than 9000 coronary artery bypass graft (CABG): incidence, risk factors and mortality Methodologic Challenges to Studying Patient Safety and Comparative Effectiveness Incidence and predictors of infection in patients undergoing primary isolated coronary artery bypass grafting: a report from a tertiary care hospital in a developing country. Risk factors for surgical site infections in neurosurgery patients with antibiotic prophylaxis. Standardized incidence rates of surgical site infection: a multicenter study in Thailand. The deadly toll of invasive methicillin-resistant Staphylococcus aureus infection in community hospitals. Poor functional status as a risk factor for surgical site infection due to methicillin-resistant Staphylococcus aureus. Surgical site infection complicating internal fixation of fractures: incidence and risk factors. Identification of risk factors by systematic review and development of risk-adjusted models for surgical site infection. Postoperative Surgical Site Infections in Patients Undergoing Spinal Tumor Surgery: Incidence and Risk Factors When to randomize, or 'Evidence-based medicine needs medicine-based evidence'. Random effect modelling of patient-related risk factors in orthopaedic procedures: results from the Dutch nosocomial infection surveillance network 'PREZIES'. Risk factors for methicillin-resistant Staphylococcus aureus surgical site infection. Risk factors for and effect of a one-year surveillance program on surgical site infection at a university hospital in Turkey. Prospective nationwide surveillance of surgical site infections after gastric surgery and risk factor analysis in the Korean Nosocomial Infections Surveillance System (KONIS). Effect of antibiotic prophylaxis on the risk of surgical site infection in orthotopic liver transplant.
abstract: Background . Although risk factors for surgical site infection ( SSI ) after cardiovascular ( CV ) surgery have been well-documented among adults , few studies have been conducted in children . We performed a case-control study to identify risk factors for hospitalized SSI in children undergoing CV surgery .  Methods . National Nosocomial Infections Surveillance System criteria were used prospect ively to identify cases of hospitalized SSI in patients who underwent CV surgery . Seventy-nine patients who underwent CV surgery without hospitalized SSI were r and omly selected as controls . Cases were compared with controls to determine preoperative , intraoperative and postoperative risk factors for hospitalized SSI . Multivariable logistic regression was performed . Results . An SSI developed in 19 of the 826 patients who underwent CV surgery  ( 2.3 cases per 100 surgeries ) during the study period . Infection was limited to soft tissue in 12 , whereas deeper infection occurred in 7 . Causative agents included Staphylococcus aureus ( 11 ) , coagulase-negative Staphylococcus ( 5 ) and Escherichia coli ( 2 ) . One patient did not have a pathogen isolated . In a multivariable analysis , duration of surgery ( odds ratio , 1.4 ; 95 % confidence interval , 1.2 to 1.8 ) and age < 1 month ( odds ratio , 14 ; 95 % confidence interval , 3.3 to 58.4 ) were independently associated with SSI . Conclusions . Age < 1 month and longer duration of surgery were independently associated with hospitalized SSI after CV surgery in children A prospect i ve open-cohort study was performed in 838 adults undergoing coronary revascularization or valve surgery  to define the risk factors for development of surgical site infections . Patients diagnosed with mediastinitis or endocarditis during follow-up were compared with patients with no such infection . After 1 year of follow-up , 22 ( 2.6 % ) patients had developed mediastinitis or endocarditis . No preoperative or intraoperative variables were identified as risk factors . By multivariate analysis of postoperative variables , respiratory insufficiency , microorganisms in blood cultures , and intensive care unit stay were independent risk factors for the development of these complications . The type of antibiotic prophylaxis had no influence on the incidence of organ or space infections after cardiac surgery 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 prospect ively 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 Purpose To investigate the incidence and risk factors associated with the development of  surgical site infections ( SSIs ) using the National Nosocomial Infection Surveillance ( NNIS ) . Methods A prospect i ve cohort study was conducted at a tertiary health care center . Infection control personnel collected general and health care related data about patients . The NNIS risk index was calculated on the basis of data relating to the operation : wound contamination class , duration of surgery , and the American Society of Anesthesiologists ( ASA ) score . Results A total of 5109 surgical procedures were included in the study . The overall cumulative incidence rate was 6.3 % . The incidence of SSIs was 2.3 % ( 63.5 % of operative procedures ) , 8.3 % ( 29.7 % ) , 34.6 % ( 6.2 % ) , and 43.3 % ( 0.6 % ) , in patients with 0 , 1 , 2 , and 3 risk index , respectively . The length of hospital stay ( OR : 1.0 ; 95 % CI : 1.053–1.075 ) , preoperative length of stay ( odds ratio [ OR ] : 1.9 ; 95 % confidence interval [ CI ] : 1.953–1.981 ) , antibiotic prophylaxis ( OR : 2.5 ; 95 % CI : 1.421–4.628 ) , drainage ( OR : 1.7 ; 95 % CI : 1.360–2.353 ) , ASA score ( OR : 1.5 ; 95 % CI : 1.235–1.946 ) , class of wound contamination ( OR : 2.0 ; 95 % CI : 1.745–2.003 ) , and NNIS risk index ( OR : 1.3 ; 95 % CI : 1.063–1.7 ) were independently associated with an increased risk for SSIs . Staphylococcus aureus was the most frequently isolated microorganism , 64 % of them being methicillin-resistant . Conclusion The aim of this study was to investigate the most important risk factors associated with the development of surgical site infections ( SSIs ) . Therefore , greater attention has been given to adherence to recommendations for the prevention and control of SSIs as well as to antibiotic prophylaxis protocol OBJECTIVE To identify risk factors associated with surgical-site infection according to the depth of infection , the cardiac procedure , and the National Nosocomial Infections Surveillance System risk index . DESIGN Prospect i ve survey conducted during a 12-month period . SETTING A 48-bed cardiac surgical department in a teaching hospital . PATIENTS Patients admitted for cardiac surgery between February 2002 and January 2003 . RESULTS Surgical-site infections were diagnosed in 3 % of the patients ( 38 of 1,268 ) . Of the 38 surgical-site infections , 20 were superficial incisional infections and 18 were mediastinitis for incidence rates of 1.6 % and 1.4 % , respectively . Cultures were positive in 28 cases and the most commonly isolated pathogen was Staphylococcus . A National Nosocomial Infections Surveillance System risk index score of 2 or greater was associated with a risk of surgical-site infection ( relative risk , 2.4 ; P < .004 ) . Heart transplantation , mechanical circulatory assistance , coronary artery bypass graft with the use of internal mammary artery , and reoperation for cardiac tamponade or pericard effusion were independent risk factors associated with surgical-site infection . CONCLUSIONS Data surveillance using incidence rates stratified by cardiac procedure and type of infection is relevant to improving infection control efforts . Risk factors in patients who developed superficial infection were different from those in patients who developed mediastinitis . Coronary artery bypass graft using internal mammary artery was associated with a high risk of surgical-site infection , and independent factors such as reoperation for cardiac tamponade or pericard effusion increased the risk of infection OBJECT The purpose of this study was to determine the incidence rate and risk factors of surgical site infections ( SSIs ) in neurosurgery for any type of surgery and any American Society of Anesthesiologists class . METHODS The authors undertook an exhaustive 18-month prospect i ve survey including patients who underwent neurosurgery .  In particular , a 30-day follow-up was completed in patients whose surgery did not involve placement of a prosthesis or implant , and 1-year follow-up was completed for patients who underwent surgery to place a prosthesis or implant . The Centers for Disease Control definition of SSI was used . Univariate and multivariate analyses were conducted ; all dependent variables found in univariate analysis were entered in the multiple regression model . A stepwise multiple logistic regression method was used . RESULTS Of the 844 patients studied , 35 SSIs were diagnosed , yielding an incidence rate of 4.1 % ( 95 % confidence interval 3.6 - 4.5 ) . Independent predictive risk factors for infection were cerebrospinal fluid leakage , external shunt , Altemeier class , and further neurosurgery . A lack of antibiotic prophylaxis was not found to be a risk factor . CONCLUSIONS Infection risk factors occur mainly during the postoperative period Background Although nasal carriage of MRSA has been identified as one of the risk factors for surgical site infection ( SSI ) with MRSA , there have been no reports of this in the orthopedics field . Methods This prospect i ve observational cohort study included 2,423 consecutive patients who were admitted to our department over 26 months and who underwent orthopedic surgery .  We examined the relationship between pre-existing nasal MRSA and subsequent occurrence of SSI with MRSA . Results 63 patients ( 2.6 % ) had a positive nasal MRSA culture . 15 patients ( 0.6 % ) developed SSI with MRSA . The occurrence of SSI with MRSA in nasal MRSA carriers was significantly higher than that in non-carriers ( 4 out of 63 ( 6.3 % ) vs. 11 out of 2,360 ( 0.5 % ) ; p < 0.001 ) ( adjusted OR : 11 ; 95 % CI : 3–37 ; p = 0.001 ) . Interpretation We recommend appropriate treatment of patients who are nasal carriers of MRSA before orthopedic surgery Background Surgical site infection ( SSI ) continues to be a major source of morbidity and mortality in developing countries despite recent advances in aseptic techniques . There is no baseline information regarding SSI in our setting therefore it was necessary to conduct this study to establish the prevalence , pattern and predictors of surgical site infection at Bug and o Medical Centre Mwanza ( BMC ) , Tanzania . Methods This was a cross-sectional prospect i ve study involving all patients who underwent major surgery in surgical wards between July 2009 and March 2010 . After informed written consent for the study and HIV testing , all patients who met inclusion criteria were consecutively enrolled into the study . Pre-operative , intra-operative and post operative data were collected using st and ardized data collection form . Wound specimens were collected and processed as per st and ard operative procedures ; and susceptibility testing was done using disc diffusion technique . Data were analyzed using SPSS software version 15 and STATA . Results Surgical site infection ( SSI ) was detected in 65 ( 26.0 % ) patients , of whom 56 ( 86.2 % ) and 9 ( 13.8 % ) had superficial and deep SSI respectively . Among 65 patients with clinical SSI  , 56(86.2 % ) had positive aerobic culture . Staphylococcus aureus was the predominant organism 16/56 ( 28.6 % ) ; of which 3/16 ( 18.8 % ) were MRSA . This was followed by Escherichia coli 14/56 ( 25 % ) and Klebsiella pneumoniae 10/56 ( 17.9 % ) . Among the Escherichia coli and Klebsiella pneumoniae isolates 9(64.3 % ) and 8(80 % ) were ESBL producers respectively . A total of 37/250 ( 14.8 % ) patients were HIV positive with a mean CD4 count of 296 cells/ml . Using multivariate logistic regression analysis , presence of pre-morbid illness ( OR = 6.1 ) , use of drain ( OR = 15.3 ) , use of iodine alone in skin preparation ( OR = 17.6 ) , duration of operation ≥ 3 hours ( OR = 3.2 ) and cigarette smoking ( OR = 9.6 ) significantly predicted surgical site infection ( SSI ) ConclusionS SI is common among patients admitted in surgical wards at BMC and pre-morbid illness , use of drain , iodine alone in skin preparation , prolonged duration of the operation and cigarette smoking were found to predict SSI . Prevention strategies focusing on factors associated with SSI is necessary in order to reduce the rate of SSI in our setting Background Sternal wound infection ( SWI ) is an uncommon but potentially life-threatening complication of cardiac surgery . Predisposing factors for SWI are multiple with varied frequencies in different studies . The purpose of this study was to assess the incidence , risk factors , and mortality of SWI after  coronary artery bypass grafting ( CABG ) at Tehran Heart Center . Methods This study prospect ively evaluated multiple risk factors for SWI  in 9201 patients who underwent CABG at Tehran Heart Center between January 2002 and February 2006 . Cases of SWI were confirmed based on the criteria of the Centers for Disease Control and Prevention . Deep SWI ( bone and mediastinitis ) was categorized according to the Oakley classification . Results In the study period , 9201 CABGs were performed with a total SWI rate of 0.47 percent ( 44 cases ) and deep SWI of 0.22 percent ( 21 cases ) . Perioperative ( in-hospital ) mortality was 9.1 % for total SWI and about 14 % for deep SWI versus 1.1 % for non-SWI CABG patients . Female gender , preoperative hypertension , high functional class , diabetes mellitus , obesity , prolonged intubation time ( more than 48 h ) , and re-exploration for bleeding were significant risk factors for developing SWI ( p = 0.05 ) in univariate analysis . In multivariate analysis , hypertension ( OR = 10.7 ) , re-exploration ( OR = 13.4 ) , and female gender ( OR = 2.7 ) were identified as significant predictors of SWI ( p < 0.05 for all ) . The rate of SWI was relatively similar in 3 groups of prophylactic antibiotic regimen ( Cefazolin , Cefazolin + Gentamycin and Cefazolin + Amikacin : 0.5 % , 0.5 % , and 0.34 % respectively ) . Conclusion Rarely reported previously , the two risk factors of hypertension and the female gender were significant risk factors in our study . Conversely , some other risk factors such as cigarette smoking and age mentioned as significant in other reports were not significant in our study . Further studies are needed for better documentation Studies of patient safety and comparative effectiveness entail unique method ologic challenges . These studies may be susceptible to systematic error , including selection bias , exposure misclassification , and outcome misclassification . They may also be vulnerable to r and om error , or confounding by a variable such as another drug , a disease , or the drug indication itself . Finally , special logistical issues can arise , including data access problems , difficulties in conveying the need for studies of certain interventions , and obstacles to gaining institutional review board approval . This article provides a conceptual overview of these method ologic issues AIM Infection following coronary artery bypass grafting ( CABG )  is a leading cause of morbidity , mortality , and increased length of hospital stay . Many studies have investigated the predictive value of known risk factors for infection in patients following CABG and conclusions have been variable and may reveal regional or institution-specific influence . The purpose of this prospect i ve study was to determine the pre- and peri-operative risk factors for infection in patients undergoing coronary artery bypass surgery in a developing country . METHODS A prospect i ve study was undertaken to collect data on 12 reported risk factors for all patients undergoing CABG during a five-year period at The Aga Khan University Hospital , Pakistan . The relationship of these risk factors to infection following CABG was evaluated . RESULTS Out of 767 consecutive patients admitted for CABG , a total of 73 ( 9.51 % ) developed 92 infections following surgery . Sternal Surgical Site Infection ( SSI ) developed in 30 patients ( 3.91 % ) , of which 29 ( 96.7 % ) were superficial and 1 ( 3.33 % ) was deep . There were 37 leg wound infections at the site of conduit harvest , and 2 cases of infection at the intra-aortic balloon pump . There were 12 cases of sepsis and 11 urinary tract infections . There were 26 cases ( 35.6 % ) of leukocytosis and 17 patients ( 23.3 % ) showed elevated erythrocyte sedimentation rate ( ESR ) . Staphylococcus aureus was the most frequently isolated pathogen ( 39.7 % ) . Bacteremia data was not collected . Of the total cases of infection following CABG , 59 required prolonged hospitalization or readmission . Univariate analysis was performed using a p-value of < 0.2 as the inclusion criteria for further analysis using logistic regression . Multivariate analysis with adjusted Relative Risk ( RR ) showed that diabetes ( P=0.002 , RR=2.3 , 95 % CI=1.4 - 4.0 ) , obesity ( P=0.036 , RR=2.2 , 95 % CI=1.0 - 4.4 ) , use of an intra-aortic balloon pump ( P=0.001 , RR=3.6 , 95 % CI=1.7 - 7.7 ) , female gender ( P=0.004 , RR=2.5 , 95 % CI=0.2 - 0.8 ) and prolonged mechanical ventilation ( P=<0.0001 , RR=6.7 , 95 % CI=2.8 - 15.5 ) were independent predictors of infection in the study population . CONCLUSION This study suggests that diabetes , obesity , use of an intra-aortic balloon pump and female gender are independent predictors of infection in patients undergoing CABG . Early and strict diabetic control and pre-operative weight reduction may reduce the incidence of infection following CABG . Contamination of these patients may occur before , during and after the operation and efforts to curb such contamination must be intensive . Further prospect i ve studies need to be undertaken to identify and establish these and other risk factors for infection in the region and elsewhere BACKGROUND This prospect i ve study aim ed to determine the spectrum and the main risk factors of surgical site infection ( SSI )  after neurosurgical procedures in our clinic . METHODS Consecutive patients undergoing neurosurgery between November 1 , 2001 , and November 1 , 2002 , were recruited for the study . All patients were followed for a minimum of 2 weeks postoperatively and all SSIs were recorded . The complete medical records of each case were review ed , and data on 14 possible risk factors were extracted . Statistical analyses were performed to identify the risk factors for SSIs . RESULTS A total of 31 postoperative SSIs were identified among 503 cases included in the study , with a result ing overall infection rate of 6.2 % . The risk of SSI was increased by age ( odds ratio [ OR ] , 1.1 ; 95 % confidence interval [ CI ] , 1.0 - 1.1 ; P = .039 ) , operation type such as " shunt operations " ( OR , 670.4 ; 95 % CI , 2.6 - 171123.1 ; P = .021 ) , presence of foreign body ( OR , 141.0 ; 95 % CI , 2.5 - 7925.9 ; P = .016 ) , presence of diabetes mellitus ( OR , 24.3 ; 95 % CI , 2.1 - 284.9 ; P = .011 ) , and intracranial pressure monitoring ( OR , 4878.9 ; 95 % CI , 23.8 - 1001229 ; P = .002 ) . The predominantly isolated microorganisms in patients with SSIs were Staphylococcus aureus ( 22 [ 71.0 % ] ) , Acinetobacter baumanii ( 5 [ 16.1 % ] ) , and Staphylococcus epidermidis ( 4 [ 12.9 % ] ) . CONCLUSIONS SSIs remain an important problem in neurosurgery . Identification of the risk factors for SSI will help physicians to improve patient care and may decrease mortality , morbidity , and health care costs of neurosurgery patients BACKGROUND No previous multicenter data regarding the incidence of  surgical site infection ( SSI ) are available in Thail and . The magnitude of the problem result ing 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 prospect i ve data collection among patients undergoing surgery in 9 hospitals in Thail and 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 st and ardization and reported in terms of st and ardized 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 INTRODUCTION Data regarding the epidemiology , treatment , and outcomes of methicillin-resistant Staphylococcus aureus ( MRSA ) infections in rural and community hospitals are limited . METHODS This cohort study was conducted at 1 tertiary care hospital and 8 community hospitals in the southeastern United States . Patients with a surgical site infection ( SSI ) and /or bacteremia due to MRSA were prospect ively identified at each study hospital during the period 1994 - 2003 . RESULTS A total of 129 patients with SSI and 564 patients with bacteremia due to MRSA were identified . Only 57 patients with SSI ( 44.2 % ) received antibiotics active against MRSA on the initial date of diagnosis ; only 95 ( 73.6 % ) received an agent active against MRSA by day 7 after diagnosis of SSI due to MRSA . Ninety-five patients with SSI due to MRSA ( 73.6 % ) were readmitted to the hospital within 90 days after their original surgery . The 1-year mortality rate among patients with SSI due to MRSA was 22 % . Inadequate therapy was also commonly given to patients with bacteremia : only 216 ( 38.3 % ) received antibiotics active against MRSA on the initial day of infection , and only 383 ( 67.9 % ) received an agent active against MRSA by day 7 after diagnosis . Approximately one-third of patients with bloodstream infection died during their initial hospitalization . Patients hospitalized in community hospitals were less likely to receive effective antimicrobial therapy  on both the day of infection and within 7 days after infection , compared with patients in the tertiary care hospital . CONCLUSION Inadequate therapy is commonly administered after diagnosis of SSI and bacteremia due to MRSA in patients in community hospitals OBJECTIVE To identify risk factors for  surgical site infection ( SSI ) due to methicillin-resistant Staphylococcus aureus ( MRSA ) . DESIGN Prospect i ve case-control study . SETTING One tertiary and 6 community-based institutions in the southeastern United States . METHODS We compared patients with SSI due to MRSA with 2 control groups : matched uninfected surgical patients and patients with SSI due to methicillin-susceptible S. aureus ( MSSA ) . Multivariable logistic regression was used to determine variables independently associated with SSI due to MRSA , compared with each control group . RESULTS During the 5-year study period , 150 case patients with SSI due to MRSA were identified and compared with 231 matched uninfected control patients and 128 control patients with SSI due to MSSA . Two variables were independently associated with SSI due to MRSA in both multivariable regression models : need for assistance with 3 or more activities of daily living ( odds ratio [ OR ] compared with uninfected patients , 3.97 [ 95 % confidence interval { CI } , 2.18 - 7.25 ] ; OR compared with patients with SSI due to MSSA , 3.88 [ 95 % CI , 1.91 - 7.87 ] ) and prolonged duration of surgery ( OR compared with uninfected patients , 1.98 [ 95 % CI , 1.11 - 3.55 ] ; OR compared with patients with SSI due to MSSA , 2.33 [ 95 % CI , 1.17 - 4.62 ] ) . Lack of independence ( ie , poor functional status ) remained associated with an increased risk of SSI due to MRSA after stratifying by age . CONCLUSIONS Poor functional status was highly associated with SSI due to MRSA in adult surgical patients , regardless of age . A patient 's level of independence can be easily determined , and this information can be used preoperatively to target preventive interventions BACKGROUND There is a dearth of data on surgical site infections ( SSIs ) complicating internal fixation of fractures from Nigeria . AIMS To determine the incidence and risk factors for SSIs following internal fixation of fracture . METHODS A cohort of 90 patients with long bone fractures that were stabilized internally with metallic devices  was studied prospect ively and retrospectively . RESULTS The incidence of SSI was 12 % . The isolated organisms were Staphylococcus aureus in four patients , Pseudomonas spp . in three , and Escherichia coli in one patient . Diabetes mellitus and perioperative transfusion with allogeneic blood were not predictive of SSI . Duration of operation longer than 120 minutes was a strong predictor ( OR 2.25 , 95 % CL 0.48 - 10.16 ) . Other risk factors were male sex ( OR 2.01 , 95 % CL 0.44 - 10.45 ) , injury-operation interval less than six months ( OR 2.00 , 95 % CL 0.22 - 46.08 ) , fracture fixation with plates and screws ( OR 1.51 , 95 % CL 0.36 - 6.40 ) , white blood cell count ( WBC ) less than 5,000 per cumm ( OR 1.50 , 95 % CL 0.15 - 16.37 ) , preoperative urinary catheterization ( OR 1.48 , 95 % CL 0.00 - 16.19 ) , and postoperative urinary catheterization ( OR 1.24 , 95 % CL 0.29 - 5.00 ) . CONCLUSION The incidence of SSI after internal fixation of long bone fractures in our centers is 12 % , and this is within the previously reported range . Use of plates and screws , WBC less than 5,000 per cumm , and perioperative urinary catheterization are important risk factors BACKGROUND  Surgical site infections ( SSIs ) are complications of surgery that cause significant postoperative morbidity . SSI has been proposed as a potential indicator of the quality of care in the context of clinical governance and monitoring of the performance of NHS organisations against targets . OBJECTIVES We aim ed to address a number of objectives . Firstly , identify risk factors for SSI , criteria for stratifying surgical procedures and evidence about the importance of postdischarge surveillance ( PDS ) . Secondly , test the importance of risk factors for SSI in surveillance data bases and investigate interactions between risk factors . Thirdly , investigate and vali date different definitions of SSI . Lastly , develop models for making risk-adjusted comparisons between hospitals . DATA SOURCES A single hospital surveillance data base was used to address objectives 2 and 3 and the UK Surgical Site Infection Surveillance Service data base to address objective 4 . STUDY DESIGN There were four elements to the research : ( 1 ) systematic review s of risk factors for SSI ( two review ers assessed titles and abstract s of studies identified by the search strategy and the quality of studies was assessed using the Newcastle Ottawa Scale ) ; ( 2 ) assessment of agreement between four SSI definitions ; ( 3 ) validation of definitions of SSI , quantifying their ability to predict clinical outcomes ; and ( 4 ) development of operation-specific risk models for SSI , with hospitals fitted as r and om effects . RESULTS Review s of SSI risk factors other than established SSI risk indices identified other risk ; some were operation specific , but others applied to multiple operations . The factor most commonly identified was duration of preoperative hospital stay . The review of PDS for SSI confirmed the need for PDS if SSIs are to be compared meaningfully over time within an institution . There was wide variation in SSI rate ( SSI% ) using different definitions . Over twice as many wounds were classified as infected by one definition only as were classified as infected by both . Different SSI definitions also classified different wounds as being infected . The two most established SSI definitions had broadly similar ability to predict the chosen clinical outcomes . This finding is paradoxical given the poor agreement between definitions . Elements of each definition not common to both may be important in predicting clinical outcomes or outcomes may depend on only a subset of elements which are common to both . Risk factors fitted in multivariable models and their effects , including age and gender , varied by surgical procedure . Operative duration was an important risk factor for all operations , except for hip replacement . Wound class was included least often because some wound classes were not applicable to all operations or were combined because of small numbers . The American Association of Anesthesiologists class was a consistent risk factor for most operations . CONCLUSIONS The research literature does not allow surgery-specific or generic risk factors to be defined . SSI definitions varied between surveillance programmes and potentially between hospitals . Different definitions do not have good agreement , but the definitions have similar ability to predict outcomes influenced by SSI . Associations between components of the National Nosocomial Infections Surveillance risk index and odds of SSI varied for different surgical procedures . There was no evidence for effect modification by hospital . Estimates of SSI% should be disseminated within institutions to inform infection control . Estimates of SSI% across institutions or countries should be interpreted cautiously and should not be assumed to reflect quality of medical care . Future research should focus on developing an SSI definition that has satisfactory psychometric properties , that can be applied in everyday clinical setting s , includes PDS and is formulated to detect SSIs that are important to patients or health services . FUNDING The National Institute for Health Research Technology Assessment programme Study Design . We conducted a retrospective , case control study on patients undergoing surgery for spinal tumors . Objective . Our aim was to determine the incidence and to identify risk factors for surgical site infections ( SSIs ) in patients undergoing surgery for spinal tumors . Summary of Background Data . SSIs after spinal tumor surgery may be particularly devastating as they may add to substantial surgical morbidity and may further exacerbate already existing neurologic deficits . Incidence and risk factors predisposing to SSIs in patients undergoing surgery for spinal tumors are not well studied yet . Methods . Between January 1995 and February 2008 , 971 procedures for spinal tumors were performed on 739 patients . Excluding sacral tumors from the current study , 895 procedures on 678 patients were review ed to identify those cases with SSIs . Furthermore , 65 infected cases and a r and omly selected subset of 162 controls were analyzed by logistic regression modeling to identify the risk factors associated with SSIs . Results . There were 678 patients that were included in this study with 364 men ( 54 % ) and 314 women ( 46 % ) , with an average age of 47.2 year . Sixty-five patients who developed SSIs underwent a total of 162 procedures including 78 procedures for wound debridement and washout . The incidence of SSIs was 8.89 % for primary nonbony spinal tumors , 9.5 % for metastatic spinal tumors , and 13.7 % for primary bony spinal tumors . Staphylococcus aureus was the most commonly isolated organism ( n = 22 of 65 , 33 % ) . In the multivariate logistic regression model , previous spinal surgeries , complex plastic closures , increasing number of comorbidities , presence of a hospital acquired infection at the time of a previous surgery , and increasing duration of hospital stay during primary surgery were significantly associated with increased likelihood of developing postoperative SSIs . Conclusion . Surgery for spine tumors appears to be associated with a higher incidence of SSI than nontumor spine surgery . Identification of perioperative risk factors will help delineate this subset of patients with high risk for developing SSIs thus potentially allowing perioperative modification for such factors , which may lead to an overall better clinical outcome and patient satisfaction The question of “ when to  r and omize  ? ” is arguably too complicated to answer , if it can even be answered definitively , in the text of a several-thous and -word article . From a broad perspective , r and omized studies are relevant to activities and decision making in scientific as well as policy setting s , while also encompassing a wide range of intersecting and overlapping topics . Representative situations include how an individual investigator decides that a r and omized trial is warranted to study a particular research question ; when the Patient-Centered Outcomes Research Institute should commission r and omized or non-r and omized research ; and whether the Food and Drug Administration always needs evidence from r and omized trials to approve new drugs . After a brief discussion of scientific terms , evidence based medicine ( EBM ) , and costs and ethical considerations , the remainder of this article will present an overarching framework to help clarify what r and omization accomplishes and what it does not — from a method ological perspective . Specifically , an argument is presented , with representative examples , focusing on comparative effectiveness research ( CER ) and promoting what can be called medicine-based evidence ( MBE ) . This report is conceptual rather than technical , commenting on general issues rather than details , although work on such details is important and available ( e.g. , see other publications from symposia1 sponsored by the Agency for Healthcare Research and Quality ) . Also of note , comments regarding particular articles are not intended to be ad hominem toward the authors , but they are rather part of a scientific discussion to advance underst and ing In the Dutch surveillance for surgical site infections ( SSIs ) , data from 70277 orthopaedic procedures with 1895 SSIs were collected between 1996 and 2003 . The aims of this study were : ( 1 ) to analyse the trends in SSIs associated with Gram-positive and Gram-negative bacteria ; ( 2 ) to estimate patient-related risk factors for deep and superficial SSIs after all orthopaedic procedures , with special attention to primary total hip arthroplasty ( THA ) ; and ( 3 ) to analyse inherent differences in infection risk between hospitals . A r and om effect model was used to estimate the odds ratios of patient-related risk factors for developing an SSI , and to describe the distribution of the most widespread bacterial species responsible for SSIs among hospitals . Gram-positive organisms , mainly staphylococci , were the main cause of both deep ( 84.0 % ) and superficial SSIs ( 69.1 % ) after orthopaedic procedures . The percentage of SSIs after THA caused by coagulase-negative staphylococci decreased over the surveillance period , while the contribution of Staphylococcus aureus increased . Temporary elevations in the incidence of the most widespread pathogen species were observed within hospitals . Patient-related factors such as the National Nosocomial Infections Surveillance System risk index or age had little effect on the predictive power of the r and om effect models . This study underlines the usefulness of a r and om effect model , which adjusts risk estimates for r and om variation between hospitals , in a multicentre study on risk factors for SSIs We prospect ively evaluated 46 possible risk factors for methicillin-resistant Staphylococcus aureus ( MRSA ) surgical site infection ( SSI ) among patients with MRSA carriage in a large intervention study . Of 6,130 study patients , 68 ( 1.1 % ) developed MRSA SSI , which occurred a median of 14 days after surgery . Risk factors associated with MRSA SSI were receipt of emergency surgery , presence of comorbid condition , receipt of immunosuppressive therapy , receipt of contaminated surgery , and a surgical duration longer than the 75th percentile . MRSA carriage on admission did not predict MRSA SSI BACKGROUND Surveillance of surgical site infection ( SSI ) is one of the most effective methods for decreasing the incidence . We determined the risk factors for SSI and the effect of a one-year surveillance program on the rate at a tertiary-care center . METHODS The annual SSI rate before the study period was determined in a preliminary study . Risk factors related to SSI , the bacteria cultured from infected sites , and the effect of surveillance were then analyzed prospect ively . Risk factors were determined by logistic regression analysis , and 95 % confidence intervals were calculated . RESULTS The incidence of SSI decreased from 12.8 % before the study to 8.8 % at the end of the surveillance period . There were 90 SSIs ( 8.8 % ) in 1,017 procedures during the study period , most of which ( 77 ; 69 % ) were detected during the hospital stay . The distribution of superficial incisional , deep incisional , and organ/space SSI was 61.1 % , 33.4 % , and 5.5 % , respectively . Prolonged preoperative hospital stay ( > 8 days ) , abdominal incision , early preoperative hair removal , inappropriate antimicrobial prophylaxis , whole blood transfusion , famotidine treatment , repair with mesh , age > 75 years , wound contamination , high American Society of Anesthesiologists score , malnutrition , diabetes mellitus , emergency surgery , obesity , and coexistent infection proved to be independent risk factors for SSI , whereas the skin closure technique , patient sex , presence of malignancy , smoking history , and duration of operation were not . Staphylococcus aureus and Escherichia coli were the bacteria isolated most frequently . Six infected patients ( 5.4 % ) died , four because of SSI . Development of SSI increased hospital expenses by around 600 US dollars per patient . CONCLUSION Surveillance even for one year decreases the incidence of SSI OBJECTIVE To evaluate the risk factors for surgical site infection ( SSI ) after gastric surgery in patients in Korea . DESIGN A nationwide prospect i ve multicenter study . SETTING Twenty university-affiliated hospitals in Korea . METHODS The Korean Nosocomial Infections Surveillance System ( KONIS ) , a Web-based system , was developed . Patients in 20 Korean hospitals from 2007 to 2009 were prospect ively monitored for SSI for up to 30 days after gastric surgery .  Demographic data , hospital characteristics , and potential perioperative risk factors were collected and analyzed , using multivariate logistic regression models . RESULTS Of the 4,238 case patients monitored , 64.9 % ( 2,752 ) were male , and mean age ( ± SD ) was 58.8 ( ± 12.3 ) years .  The SSI rates were 2.92 , 6.45 , and 10.87 per 100 operations for the National Nosocomial Infections Surveillance system risk index categories of 0 , 1 , and 2 or 3 , respectively . The majority ( 69.4 % ) of the SSIs observed were organ or space SSIs . The most frequently isolated microorganisms were Staphylococcus aureus and Klebsiella pneumoniae . Male sex ( odds ratio [ OR ] , 1.67 [ 95 % confidence interval ( CI ) , 1.09 - 2.58 ] ) , increased operation time ( 1.20 [ 1.07 - 1.34 ] per 1-hour increase ) , reoperation ( 7.27 [ 3.68 - 14.38 ] ) , combined multiple procedures ( 1.79 [ 1.13 - 2.83 ] ) , prophylactic administration of the first antibiotic dose after skin incision ( 3.00 [ 1.09 - 8.23 ] ) , and prolonged duration ( ≥7 days ) of surgical antibiotic prophylaxis ( SAP ; 2.70 [ 1.26 - 5.64 ] ) were independently associated with increased risk of SSI . CONCLUSIONS Male sex , inappropriate SAP , and operation-related variables are independent risk factors for SSI after gastric surgery Surgical site infections are common bacterial infections in orthotopic liver transplantation . The purpose of this study was to determine the incidence , timing , location , and risk factors , specifically antibiotic prophylaxis , for surgical site infections . A prospect i ve study was performed that included a population of 1222 consecutive patients ( 73.0 % males ) who underwent liver transplantation in Spanish hospitals belonging to the Red de Estudio de la Infección en el Trasplante research network . One hundred seven patients developed surgical site infections .  The predominant infection sites were incisional wound ( 53 episodes ) and peritonitis ( 40 episodes ) . The timing of the organ/space surgical site infections was slightly delayed in comparison with incisional surgical site infections . Enterococcus spp . , Escherichia coli , Staphylococcus aureus , and Acinetobacter baumannii were the predominant pathogens .  Choledochojejunal or hepaticojejunal reconstruction  ( odds ratio , 4.2 ; 95 % confidence interval , 1.6 - 10.7 ) , previous liver or kidney transplant ( odds ratio , 2.6 ; 95 % confidence interval , 1.1 - 6.3 ) , and more than 4 red blood cell units transfused ( odds ratio , 2.0 ; 95 % confidence interval , 1.1 - 3.4 ) were independently associated with the development of surgical site infections .  Biliary reconstruction by choledochojejunostomy or hepaticojejunostomy increases the risk of surgical site infections
target: AND RELEVANCE In a broad review of published literature , risk factors for SSI were characterized as describing reduced fitness , patient frailty , surgery duration , and complexity .
background: IMPORTANCE Surgical site infection ( SSI ) complicates 2 - 5 % of surgeries in the United States .
  Severity of SSI ranges from superficial skin infection to life-threatening conditions such as severe sepsis , and SSIs are responsible for increased morbidity , mortality , and economic burden associated with surgery .
  Staphylococcus aureus ( S. aureus ) is a commonly-isolated organism for SSI , and methicillin-resistant S. aureus SSI incidence is increasing globally .
  OBJECTIVE The objective of this systematic review was to characterize risk factors for SSI within observational studies describing incidence of SSI in a real-world setting .