Risk factors for methicillin-resistant Staphylococcus aureus surgical site infection. Surgical-site infection rates and risk factor analysis in coronary artery bypass graft surgery. Poor functional status as a risk factor for surgical site infection due to methicillin-resistant Staphylococcus aureus. Decolonisation of MRSA and its effect on surgical site infections--a study in a tertiary care institute. Surgical-site infections at Kilimanjaro Christian Medical Center. Microbiology of surgical site infections and associated antimicrobial use among Vietnamese orthopedic and neurosurgical patients. Is nasal carriage of Staphylococcus aureus the main acquisition pathway for surgical-site infection in orthopaedic surgery? Lower complication rates for cranioplasty with peri-operative bundle Postoperative Surgical Site Infections in Patients Undergoing Spinal Tumor Surgery: Incidence and Risk Factors Risk factors for and effect of a one-year surveillance program on surgical site infection at a university hospital in Turkey. The deadly toll of invasive methicillin-resistant Staphylococcus aureus infection in community hospitals. Does Minimally Invasive Surgery Have a Lower Risk of Surgical Site Infections Compared With Open Spinal Surgery? Six years of surgical wound infection surveillance at a tertiary care center: review of the microbiologic and epidemiological aspects of 20,007 wounds. Diminishing surgical site infections in Australia: time trends in infection rates, pathogens and antimicrobial resistance using a comprehensive Victorian surveillance program, 2002-2013. Random effect modelling of patient-related risk factors in orthopaedic procedures: results from the Dutch nosocomial infection surveillance network 'PREZIES'. Risk prediction for Staphylococcus aureus surgical site infection following cardiothoracic surgery; A secondary analysis of the V710-P003 trial Predictors of surgical site infections among patients undergoing major surgery at Bugando Medical Centre in Northwestern Tanzania Effect of perioperative mupirocin and antiseptic body wash on infection rate and causative pathogens in patients undergoing cardiac surgery. Risk factors for deep surgical site infections after spinal fusion Prophylactic Antibiotics in Open Fractures: A Pilot Randomized Clinical Safety Study Prospective nationwide surveillance of surgical site infections after gastric surgery and risk factor analysis in the Korean Nosocomial Infections Surveillance System (KONIS). Positive nasal culture of methicillin-resistant Staphylococcus aureus (MRSA) is a risk factor for surgical site infection in orthopedics Effect of a preoperative decontamination protocol on surgical site infections in patients undergoing elective orthopedic surgery with hardware implantation.
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 The Victorian Infection Control Surveillance Project ( VICSP ) is a multicenter collaborative surveillance project established by infection control practitioners . Five public hospitals contributed data for patients undergoing coronary artery bypass graft ( CABG ) surgery .  OBJECTIVE To determine the aggregate and comparative interhospital surgical-site infection ( SSI ) rates for patients undergoing CABG surgery and the risk factors for SSI in this patient group . METHOD Each institution used st and ardized definitions of SSI , risk adjustment , and reporting methodology according to the National Nosocomial Infections Surveillance System of the Centers for Disease Control and Prevention . Data on potential risk factors were prospect ively collected . RESULTS For 4,474 patients undergoing CABG surgery , the aggregate SSI rate was 7.8 infections per 100 procedures ( 95 % confidence interval [ CI95 ] , 7.0 - 8.5 ) , with individual institutions ranging between 4.5 and 10.7 infections per 100 procedures . Multivariate risk factor analysis demonstrated age ( odds ratio [ OR ] , 1.02 ; CI95 , 1.01 - 1.04 ; P < .001 ) , obesity ( OR , 1.8 ; CI95 , 1.4 - 2.3 ; P < .001 ) , and diabetes mellitus ( OR , 1.6 ; CI95 , 1.2 - 2.1 ; P < .001 ) as independent predictors of SSI . Three hundred thirty-four organisms were isolated from 296 SSIs . Of the total SSIs , methicillin-resistant Staphylococcus aureus was isolated from 32 % , methicillin-sensitive S. aureus from 24 % , gram-negative bacilli ( eg , Enterobacter and Escherichia coli ) from 18 % , and miscellaneous organisms from the remainder . CONCLUSION We documented aggregate and comparative SSI rates among five Victorian public hospitals performing CABG surgery and defined specific independent risk factors for SSI . VICSP data offer opportunities for targeted interventions to reduce SSI following cardiac surgery 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 Two-thirds of surgical site infections ( SSI ) because of Staphylococcus aureus are caused by Methicillin resistant Staphylococcus aureus ( MRSA ) . This study was done to assess the efficacy of topical 2 % mupirocin with 2 % chlorhexidine gluconate body wash in decolonizing MRSA and its impact in preventing SSI because of MRSA . The various risk factors associated with MRSA carriers and SSI were also studied because of paucity of data in the developing world . METHODS We did a non-r and omised interventional trial in 602 patients undergoing elective general surgical operations . All patients in case ( 297 ) group were screened for MRSA and those positive were decolonised with topical 2 % mupirocin calcium ointment and daily baths with 2 % chlorhexidine antiseptic solution for 5 days . Control ( 305 ) group patients underwent surgery without decolonisation . Postoperatively , all patients were followed up for SSI for 30 days . RESULTS Prevalence of MRSA carriers was 7.5 % with decolonisation rate of 95.2 % . The SSI incidence was 21.3 % . The significant risk factors for SSI were type of anaesthesia ( p = 0.002 ) , duration of surgery ( p = 0.001 ) and preoperative hospital stay ( p = 0.001 ) . There was a significant association between MRSA carrier positivity at the time of surgery and SSI ( p = 0.041 ) . CONCLUSIONS There was no reduction in rate of SSI or other nosocomial infections in patients undergoing elective general surgical operations following preoperative MRSA decolonisation with 2 % mupirocin and 2 % chlorhexidine gluconate in MRSA carriers . MRSA carrier status was a significant risk factor for SSI but not for other nosocomial infections A five-month prospect i ve survey of  surgical-site infections ( SSI )  was conducted in the department of general surgery at Kilimanjaro Christian Medical Center , Tanzania . SSI were classified according to Centers for Disease Control and Prevention ( CDC ) criteria and identified by bedside surveillance and post-discharge follow-up . This study showed that 77 ( 19.4 % ) of the patients developed SSI  . Twenty-eight ( 36.4 % ) of these infections were apparent only after discharge from hospital . Eighty-seven percent of those who developed SSI had received antibiotic prophylaxis . Significant risk factors for developing SSI during hospital stay were : operations classified as contaminated or dirty , operations lasting for more than 50 min and the length of preoperative stay . The only significant risk factor for those who developed SSI after discharge was having undergone a clean-contaminated operation . Staphylococcus aureus was the most frequently isolated micro-organism followed by Escherichia coli and Klebsiella spp . , most of which were multi-resistant . An exception was S. aureus where 54.5 % of the isolates were fully susceptible . The incidence of SSI and the prevalence of antibiotic resistance in this teaching and tertiary care hospital are high . The risk factors were similar to those reported from countries with more re sources . The findings suggest that infection prevention measures , particularly antibiotic prophylaxis , should be re-evaluated OBJECTIVES To determine the pathogens associated with  surgical site infections ( SSIs )  and describe patterns of antimicrobial use and resistance in orthopedic and neurosurgical patients in a large university hospital in Vietnam . DESIGN Prospect i ve cohort study . SETTING Cho Ray Hospital , Ho Chi Minh City , Vietnam . PATIENTS All patients who had operations during a 5-week study period . RESULTS Of 702 surgical patients , 80 ( 11.4 % ) developed an SSI . The incidence of SSI among orthopedic patients was 15.2 % ( 48 of 315 ) , and among neurosurgical patients it was 8.3 % ( 32 of 387 ) . Postoperative bacterial cultures of sample s from the surgical sites were performed for 55 ( 68.8 % ) of the 80 patients with SSI ; 68 wound swab specimens and 10 cerebrospinal fluid sample s were cultured . Of these 78 cultures , 60 ( 76.9 % ) were positive for a pathogen , and 15 ( 25 % ) of those 60 cultures yielded multiple pathogens . The 3 most frequently isolated pathogens were Pseudomonas aeruginosa ( 29.5 % of isolates ) , Staphylococcus aureus ( 11.5 % of isolates ) , and Escherichia coli ( 10.3 % of isolates ) . Ninety percent of S. aureus isolates were methicillin resistant , 91 % of P. aeruginosa isolates were ceftazidime resistant , and 38 % of E. coli isolates were cefotaxime resistant . All but 1 of the 702 patients received  antimicrobial therapy  after surgery , and the median duration of antimicrobial therapy was 11 days . Commonly used antimicrobials included aminopenicillins and second- and third-generation cephalosporins . Two or more agents were given to 634 ( 90 % ) of the patients , and most combination drug regimens ( 86 % ) included an aminoglycoside . CONCLUSIONS Our data indicate that the incidence of SSI is high in our study population , that the main pathogens causing SSI are gram-negative bacteria and are often resistant to commonly used antimicrobials , that the use of broad-spectrum antimicrobials after surgery is widespread , and that implementation of interventions aim ed at promoting appropriate and evidence -based use of antimicrobials are needed in Vietnam The endogenous or exogenous origin of Staphylococcus aureus , responsible for orthopaedic surgical-site infections ( SSI ) , remains debated . We conducted a multicentre prospect i ve cohort study to analyse the respective part of exogenous contamination and endogenous self-inoculation by S. aureus during elective orthopaedic surgery .  The nose of each consecutive patient was sample d before surgery . Strains of S. aureus isolated from the nose and the wound , in the case of SSI , were compared by antibiotypes or pulsed-field gel electrophoresis ( PFGE ) . A total of 3,908 consecutive patients undergoing orthopaedic surgery were included . Seventy-seven patients developed an SSI  ( 2 % ) , including 22 related to S. aureus ( 0.6 % ) . S. aureus was isolated from the nose of 790 patients ( 20.2 % ) at the time of surgery . In the multivariate analysis , S. aureus nasal carriage was found to be a risk factor for S. aureus SSI in orthopaedic surgery . However , only nine subjects exhibiting S. aureus SSI had been found to be carriers before surgery : when compared , three pairs of strains were considered to be different and six similar . In most cases of S. aureus SSI , either an endogenous origin could not be demonstrated or pre-operative nasal colonisation retrieved a strain that was different from the one recovered from the surgical BACKGROUND The overall benefits of craniectomy must include procedural risks from cranioplasty . Cranioplasty carries a high risk of surgical site infections ( SSI ) particularly with antibiotic resistant bacteria . The goal of this study was to measure the effect of a cranioplasty bundle on peri-operative complications . METHODS The authors queried a prospect i ve , inpatient neurosurgery data base at Kaiser Sacramento Medical Center for craniectomy and cranioplasty over a 7 year period . 57 patients who underwent cranioplasties were identified . A retrospective chart review was completed for complications , including surgical complications such as SSI , wound dehiscence , and re-do cranioplasty . We measured cranioplasty complication rates before and after implementation of a peri-operative bundle , which consisted of peri-operative vancomycin ( 4 doses ) , a barrier dressing through post-operative day ( POD ) 3 , and de-colonization of the surgical incision using topical chlorhexidine from POD 4 to 7 . RESULTS The rate of MRSA colonization in cranioplasty patients is three times higher than the average seen on ICU admission screening ( 19 % vs. 6 % ) . The cranioplasty surgical complication rate was 22.8 % and SSI rate was 10.5 % . The concurrent SSI rate for craniectomy was 1.9 % . Organisms isolated were methicillin-resistant Staphylococcus aureus ( 4 ) , methicillin-sensitive S. aureus ( 1 ) , Propionibacterium acnes ( 1 ) , and Escherichia coli ( 1 ) . Factors associated with SSI were peri-operative vancomycin ( 68.6 % vs. 16.7 % , p=0.0217 ) . Complication rates without ( n=21 ) and with ( n=36 ) the bundle were : SSI ( 23.8 % vs. 2.8 % , p=0.0217 ) and redo cranioplasty ( 19 % vs. 0 % , p=0.0152 ) . Bundle use did not affect rates for superficial wound dehiscence , seizures , or hydrocephalus . CONCLUSIONS The cranioplasty bundle was associated with reduced SSI rates and the need for re-do cranioplasties 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 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 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 Background Surgical site infection ( SSI ) ranges from 1.9 % to 5.5 % in most large series . Minimally invasive surgery ( MIS ) has been postulated to reduce SSI rates . Questions / purpose s(1 ) Is MIS associated with a lower incidence of SSI compared with open spinal surgery ? ( 2 ) Are there other independent risk factors associated with SSI ? ( 3 ) What bacteria are most common in spinal SSI ? Methods Medical records of 2299 patients who underwent transforaminal lumbar interbody fusion , laminectomy , or discectomy  were analyzed and selected for a nested case-control analysis . Twenty-seven cases with SSI were matched with 162 control subjects without SSI stratified based on procedure performed within 28 days of the case ’s date of surgery . Patients were identified from an institutional data base at a tertiary care hospital .  MIS involved spinal procedures performed through a tubular retractor system . Univariate and multivariate analyses were performed . Results Patients undergoing open spinal surgery were 5.77 times more likely to develop SSI compared with MIS approaches ( odds ratio [ OR ] , 5.77 ; 95 % confidence interval [ CI ] , 1.0–32.7 ; p = 0.048 ) . Also , from the multivariate regression model , diabetes ( OR , 4.7 ; 95 % CI , 1.3–17.0 ; p = 0.018 ) , number of levels operated on ( OR , 3.5 ; 95 % CI , 1.6–7.5 ; p = 0.001 ) , and body mass index ( OR , 1.2 ; 95 % CI , 1.0–1.3 ; p = 0.010 ) were predictive of an increased risk in SSI . Staphylococcus aureus was most frequently identified , being present in 12 of 21 ( 52.4 % ) patients in whom positive cultures were obtained . Four of the 12 patients had methicillin-resistant S aureus infection . Conclusions In our series , MIS has a lower incidence of SSI . The risk factors predictive of SSI should be further evaluated in well- design ed prospect i ve trials . Level of Evidence Level III , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence HYPOTHESES ( 1 ) Antibiotic restriction policies result in alteration of microbiologic features of  surgical site infections ( SSIs )  and ( 2 ) reported SSI rates are underestimated when postdischarge surveillance is not included in SSI surveillance efforts . DESIGN Retrospective analysis of prospect ively collected SSI surveillance data . PATIENTS AND METHODS We compared initial microbial isolates from SSIs between ( 1 ) January 1 , 1993 , and December 31 , 1995 , and ( 2 ) January ; 1 , 1996 , and December 31 , 1998 .  Antibiotic restriction policies were implemented at Fairview-University Medical Center , Minneapolis , Minn , on March 1 , 1995 . For the combined periods ( January 1 , 1993 , to December 31 , 1998 ) , we determined  SSI rates for 20007 operations according to the extent of bacterial contamination at surgery ( wound class ) . Then , we analyzed SSI rates for 10559 of these operations ( selected based on availability of Anesthesia Society of America score and type of procedure ) using the surgical wound risk index ( wound class , Anesthesia Society of America score , and length of operation ) . We categorized SSI rates by 17 procedures for comparison with SSI rates  reported by 286 hospitals that contributed data confidentially and voluntarily to the National Nosocomial Infections Surveillance System in 1998 . We compared SSI rates with and without postdischarge surveillance . RESULTS Coagulase-negative staphylococcus and group D enterococcus were the 2 most frequent isolates before and after antibiotic restriction policies were implemented . C and ida albicans isolates decreased from 7.9 % ( 1993 - 1995 ) to 6.5 % ( 1996 - 1998 ; P=.46 ) . Methicillin-resistant Staphylococcus aureus ( 1.8 % of isolates ) and vancomycin-resistant enterococcus ( 2.4 % of isolates ) organisms were first identified between 1996 and 1998 . Our SSI rates were 2.6 % for class I wounds , 3.6 % for class II wounds , and 10.5 % for class III/IV wounds ; 53.9 % of SSIs were identified after hospital discharge . CONCLUSIONS Antibiotic restriction policies did not alter the microbial spectrum of SSIs during the observation period . Reporting SSI rates in the absence of postdischarge surveillance dramatically underestimates actual SSI rates , especially in tertiary care hospitals that provide care for large population s of elderly and immunosuppressed patients OBJECTIVE To evaluate time trends in  surgical site infection ( SSI ) rates  and SSI pathogens in Australia . DESIGN Prospect i ve multicenter observational cohort study . SETTING A group of 81 Australian healthcare facilities participating in the Victorian Healthcare Associated Infection Surveillance System ( VICNISS ) . PATIENTS All patients underwent surgeries performed between October 1 , 2002 , and June 30 , 2013 .  National Healthcare Safety Network SSI surveillance methods were employed by the infection prevention staff at the participating hospitals . INTERVENTION Procedure-specific risk-adjusted SSI rates  were calculated . Pathogen-specific and antimicrobial-resistant ( AMR ) infections were modeled using multilevel mixed-effects Poisson regression . RESULTS A total of 183,625 procedures were monitored , and 5,123 SSIs were reported . Each year of observation was associated with 11 % risk reduction for superficial SSI ( risk ratio [ RR ] , 0.89 ; 95 % confidence interval [ CI ] , 0.88 - 0.90 ) , 9 % risk reduction for deep SSI ( RR , 0.91 ; 95 % CI , 0.90 - 0.93 ) , and 5 % risk reduction for organ/space SSI ( RR , 0.95 ; 95 % CI , 0.93 - 0.97 ) . Overall , 3,318 microbiologically confirmed SSIs were reported . Of these SSIs , 1,174 ( 35.4 % ) were associated with orthopedic surgery , 827 ( 24.9 % ) with coronary artery bypass surgery , 490 ( 14.8 % ) with Caesarean sections , and 414 ( 12.5 % ) with colorectal procedures . Staphylococcus aureus was the most frequently identified pathogen , and a statistically significant increase in infections due to ceftriaxone-resistant Escherichia coli was observed ( RR , 1.37 ; 95 % CI , 1.10 - 1.70 ) . CONCLUSIONS St and ardized SSI surveillance methods have been implemented in Victoria , Australia . Over an 11-year period , diminishing rates of SSIs have been observed , although AMR infections increased significantly . Our findings facilitate the refinement of recommended surgical antibiotic prophylaxis regimens and highlight the need for a more expansive national surveillance strategy to identify changes in epidemiology 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 Background Identifying patients undergoing cardiothoracic surgery at high risk of Staphylococcus aureus surgical site infection ( SSI ) is a prerequisite for implementing effective preventive interventions . The objective of this study was to develop a risk prediction model for S. aureus SSI or bacteremia after cardiothoracic surgery based on pre-operative variables . Material s/ Methods Data from the Merck Phase IIb/III S. aureus vaccine ( V710-P003 ) clinical trial were analyzed . In this r and omized placebo-controlled trial , the effect of preoperative vaccination against S. aureus was investigated in patients undergoing cardiothoracic surgery . The primary outcome was deep/superficial S. aureus SSI or S. aureus bacteremia through day 90 after surgery . Performance , calibration , and discrimination of the final model were assessed . Results Overall 164 out of 7,647 included patients ( 2.1 % ) developed S. aureus infection ( 149 SSI , 15 bacteremia , 28 both ) . Independent risk factors for developing the primary outcome were pre-operative colonization with S. aureus ( OR 3.08 , 95 % confidence interval [ CI ] 2.23–4.22 ) , diabetes mellitus ( OR 1.87 , 95 % CI 1.34–2.60 ) , BMI ( OR 1.02 per kg/m2 , 95 % CI 0.99–1.05 ) , and CABG ( OR 2.67 , 95 % CI 1.91–3.78 ) . Although vaccination had a significant ( albeit modest ) protective effect , it was omitted from the model because its addition did not significantly change the coefficients of the final model and V710-vaccine development has been discontinued due to insufficient efficacy . The final prediction model had moderate discriminative accuracy ( AUC-value , 0.72 ) . Conclusion Pre-operative S. aureus colonization status , diabetes mellitus , BMI , and type of surgical procedure moderately predicted the risk of S. aureus SSI and /or bacteremia among patients undergoing cardiothoracic 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 INTRODUCTION Preoperative nasal mupirocin has been shown to reduce surgical site infections ( SSIs ) in patients undergoing cardiac surgery . We analyzed the effect of mupirocin plus antiseptic body wash on SSI rate and etiology . METHODS Prospect i ve SSI surveillance was done for patients undergoing cardiac surgery before and after implementation of mupirocin nasal ointment and chlorhexidine/octenidine body wash .  RESULTS Overall SSI rate was 8.6 % ( 81 out of 945 ) for the control and 6.9 % ( 58 out of 842 ) for the intervention cohort ( P = .19 ) . In multivariable analysis , the study protocol was associated with an odds ratio of 0.61 ( 95 % confidence interval , 0.41 - 0.91 ; P = .015 ) with regard to any SSI . This effect was exclusively due to a reduction in superficial SSIs and was observed both in patients with preoperative and postoperative treatment initiation . Coagulase-negative staphylococci ( CoNS ) , the most commonly isolated pathogen , were found in 37 % and 48 % ( P = .19 ) of patients in the control and the intervention cohort , respectively . CoNS were methicillin resistant in 69 % of cases . CONCLUSIONS Mupirocin and antiseptic body wash reduced the rate of superficial but not deep or organ/space SSIs . Postoperative patient treatment may be critical in reducing the risk for superficial SSI , presumably due to a reduction of bacterial skin load . A high proportion of SSI was due to methicillin-resistant CoNS and thus not covered by routine perioperative antimicrobial prophylaxis Surgical site infections ( SSI ) are undesired and troublesome complications after spinal surgery . The reported infection rates range from 0.7 to 11.9 % , depending on the diagnosis and the complexity of the procedure . Besides operative factors , patient characteristics could also account for increased infection rates . Because the medical , economic and social costs of SSI are enormous , any significant reduction in risks will pay dividends . The purpose of this study is to compare patients who developed deep SSI following lumbar or thoracolumbar spinal fusion with a r and omly selected group of patients who did not develop this complication in order to identify changeable risk factors . With a case – control analysis nested in a historical cohort of patients who had had a spinal fusion between January 1999 and December 2008 , we identified 36 cases with deep SSI ( CDC criteria ) . Information regarding patient-level and surgical-level risk factors was derived from st and ardized but routinely recorded data and compared with those acquired in a r and om selection of 135 uninfected patients . Univariate analyses and a multivariate logistic regression were performed . The overall rate of infection in 1,615 procedures ( 1,568 patients ) was 2.2 % . A positive history of spinal surgery was associated with an almost four times higher infection rate ( OR = 3.7 , 95 % BI = 1.6–8.6 ) . The risk of SSI increased with the number of levels fused , patients with diabetes had an almost six times higher risk and smokers had more than a two times higher risk for deep SSI . The most common organism cultured was Staphylococcus aureus . All infected patients underwent at least one reoperation , including an open débridement and received appropriate antibiotics to treat the organism . Patients who had had a previous spinal surgery are a high-risk group for infection compared with those that never had surgery . Total costs associated with preventive measures are substantial and should be compensated by health care insurance companies by means of separate clinical pathways . High-risk patients should be informed about the increased risk of complications Objective : To develop preliminary data on Staphylococcus aureus colonization and surgical site infections ( SSIs ) in patients with open fractures who received st and ard antibiotic prophylaxis  compared with a regimen including targeted methicillin-resistant Staphylococcus aureus ( MRSA ) coverage . Design : R and omized prospect i ve clinical trial . Patients : Adult patients who presented to the emergency department with an open fracture between April 2009 and July 2011 . Interventions : One hundred thirty patients were r and omized to receive prophylaxis with either cefazolin alone ( control arm ) or vancomycin and cefazolin ( experimental arm ) from presentation to the emergency department until 24 hours after the surgical intervention . Screening for S. aureus carriage was performed with nares swabs and predebridement and postdebridement open fracture wound swabs . Patients underwent prospect i ve assessment for the development of SSI for no less than 30 days and up to 12 months . Results : Nasal colonization of methicillin-sensitive S. aureus and MRSA among the sample was 20 % and 3 % , respectively . No significant difference in the rates of SSI was observed between the study arms ( 15 % vs 19 % , respectively , P = 0.62 ) . Staphylococcus aureus caused 55 % of the deep incisional/organ space SSI , with 18 % attributed to MRSA . A significantly higher rate of MRSA SSIs was observed among MRSA carriers compared with noncarriers ( 33 % vs 1 % , respectively , P = 0.003 ) . Conclusions : Staphylococcus aureus nasal colonization in trauma patients with open fractures is similar to that of the general community . In this pilot study , the addition of vancomycin to st and ard antibiotic prophylaxis was found safe , but its efficacy should be evaluated in a larger multiinstitutional trial . Level of Evidence : Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence 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 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 IMPORTANCE Surgical site infections ( SSIs ) , commonly caused by methicillin-resistant Staphylococcus aureus ( MRSA ) , are associated with significant morbidity and mortality , specifically when hardware is implanted in the patient . Previously , we have demonstrated that a preoperative decontamination protocol using chlorhexidine gluconate washcloths and intranasal antiseptic ointment is effective in eradicating MRSA in the nose and on the skin of patients . OBJECTIVE To examine the effect of a decontamination protocol on SSIs in patients undergoing elective orthopedic surgery with hardware implantation . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve data base of patients undergoing elective orthopedic surgery with hardware implantation at the Michael E. DeBakey Veterans Affairs Medical Center in Houston , Texas , was analyzed from October 1 , 2012 , to December 31 , 2013 . Cohort groups before and after the intervention were compared . INTERVENTIONS Starting in May 2013 , during their preoperative visit , all of the patients watched an educational video about MRSA decontamination and were given chlorhexidine washcloths and oral rinse and nasal povidone-iodine solution to be used the night before and the morning of scheduled surgery . MAIN OUTCOMES AND MEASURES Thirty-day SSI rates were collected according to the definitions of the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance . Data on demographics , comorbidities such as chronic obstructive pulmonary disease and coronary artery disease , tobacco use , alcohol use , and body mass index were also collected . Univariate analysis was performed between the 2 groups of patients . Multivariate analysis was used to identify independent predictors of SSI . RESULTS A total of 709 patients were analyzed ( 344 controls and 365 patients who were decolonized ) . Both groups were well matched with no significant differences in age , body mass index , sex , or comorbidities . All of the patients ( 100 % ) completed the MRSA decontamination protocol . The SSI rate in the intervention group was significantly lower ( 1.1 % ; 4 of 365 patients developed an SSI ) than the SSI rate in the control group ( 3.8 % ; 13 of 344 patients developed an SSI ) ( P = .02 ) . Multivariate logistic regression identified MRSA decontamination as an independent predictor of not developing an SSI ( adjusted odds ratio , 0.24 [ 95 % CI , 0.08 - 0.77 ] ; P = .02 ) . CONCLUSIONS AND RELEVANCE Our study demonstrates that preoperative MRSA decontamination with chlorhexidine washcloths and oral rinse and intranasal povidone-iodine decreased the SSI rate by more than 50 % among patients undergoing elective orthopedic surgery with hardware implantation . Universal decontamination using this low-cost protocol may be considered as an additional prevention strategy for SSIs in patients undergoing orthopedic surgery with hardware implantation and warrants further study
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 .
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 .