Independent risk factors for surgical site infection after cesarean delivery in a rural tertiary care medical center

Objective.To examine risk factors for surgical site infection (SSI) following spinal surgery and to analyze the associations between a surgeon's years of operating experience and surgical specialty and patients' SSI risk.Design.Case-control study.Setting.A tertiary care facility and a community hospital in Durham, North Carolina.Patients.Each case patient who developed an SSI complicating laminectomy was matched with 2 noninfected control patients by hospital, year of surgery, and National Nosocomial Infection Surveillance System risk index score.Results.Forty-one case patients with SSI complicating laminectomy and 82 matched control patients were analyzed. Nonwhite race, diabetes and an elevated body mass index (BMI) were more common among case patients than among control patients. Subjects with a BMI greater than 35 were more likely to undergo a prolonged procedure, compared with case patients who had a BMI of 35 or less. The SSI rate for patients operated on by neurosurgeons was 28%, compared with 43% for patients operated on by orthopedic surgeons (odds ratio [OR], 0.5; P = .12). The number of years of operating experience were not associated with SSI risk. Multivariate analysis revealed diabetes (OR, 4.2 [95% confidence interval {CI}, 1.1-16.3]; P = .04), BMI greater than 35 (OR, 7.1 [95% CI, 1.8-28.3]; P = .005), and laminectomy at a level other than cervical (OR, 6.7 [95% CI, 1.4-33.3]; P = .02) as independent risk factors for SSI following laminectomy.Conclusion.Diabetes, obesity, and laminectomy at a level other than cervical are independent risk factors for SSI following laminectomy. Preoperative weight loss and tight perioperative control of blood glucose levels may reduce the risk of SSI in laminectomy patients.

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Risk Factors for Surgical Site Infection After Low Transverse Cesarean Section

Infection Control and Hospital Epidemiology ◽

10.1086/587810 ◽

2008 ◽

Vol 29 (6) ◽

pp. 477-484 ◽

Cited By ~ 103

Author(s):

Margaret A. Olsen ◽

Anne M. Butler ◽

Denise M. Willers ◽

Preetishma Devkota ◽

Gilad A. Gross ◽

...

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Surgical Site Infection ◽

Tertiary Care ◽

University Teaching ◽

Skin Closure ◽

Care Hospital ◽

Site Infection ◽

Increased Risk ◽

Independent Risk Factors

Background.Independent risk factors for surgical site infection (SSI) after cesarean section have not been well documented, despite the large number of cesarean sections performed and the relatively common occurrence of SSI.Objective.To determine independent risk factors for SSI after low transverse cesarean section.Design.Retrospective case-control study.Setting.Barnes-Jewish Hospital, a 1,250-bed tertiary care hospital.Patients.A total of 1,605 women who underwent low transverse cesarean section during the period from July 1999 to June 2001.Methods.Using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for SSI or wound complication and/or data on antibiotic use during the surgical hospitalization or at readmission to the hospital or emergency department, we identified potential cases of SSI in a cohort of patients who underwent a low transverse cesarean section. Cases of SSI were verified by chart review using the definitions from the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System. Control patients without SSI or endomyometritis were randomly selected from the population of patients who underwent cesarean section. Independent risk factors for SSI were determined by logistic regression.Results.SSIs were identified in 81 (5.0%) of 1,605 women who underwent low transverse cesarean section. Independent risk factors for SSI included development of subcutaneous hematoma after the procedure (adjusted odds ratio [aOR], 11.6 [95% confidence interval {CI}, 4.1–33.2]), operation performed by the university teaching service (aOR, 2.7 [95% CI, 1.4–5.2]), and a higher body mass index at admission (aOR, 1.1 [95% CI, 1.0–1.1]). Cephalosporin therapy before or after the operation was associated with a significantly lower risk of SSI (aOR, 0.2 [95% CI, 0.1–0.5]). Use of staples for skin closure was associated with a marginally increased risk of SSI.Conclusions.These independent risk factors should be incorporated into approaches for the prevention and surveillance of SSI after surgery.

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Risk factors for surgical site infection after cesarean delivery: A case-control study

American Journal of Infection Control ◽

10.1016/j.ajic.2018.07.023 ◽

2019 ◽

Vol 47 (2) ◽

pp. 164-169 ◽

Cited By ~ 2

Author(s):

Khalid BM Saeed ◽

Paul Corcoran ◽

Mairead O'Riordan ◽

Richard A. Greene

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Cesarean Delivery ◽

Case Control Study ◽

Case Control ◽

Site Infection ◽

Control Study

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A case-control study of risk factors for surgical site infection after cesarean delivery in eastern Burkina Faso

International Journal of Gynecology & Obstetrics ◽

10.1016/j.ijgo.2016.08.018 ◽

2016 ◽

Vol 135 (S1) ◽

pp. S107-S110 ◽

Cited By ~ 3

Author(s):

Boezemwendé Kaboré ◽

Georges Soudouem ◽

Ibrahima Seck ◽

Tieba Millogo ◽

Wambi Maurice Evariste Yaméogo ◽

...

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Burkina Faso ◽

Cesarean Delivery ◽

Case Control Study ◽

Case Control ◽

Site Infection ◽

Control Study

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Risk Factors for Inpatient Hypoglycemia in a Tertiary Care Medical Center

10.1210/endo-meetings.2011.part4.p3.p3-450 ◽

2011 ◽

pp. P3-450-P3-450

Author(s):

Jeremy R Grogg ◽

Pooja Singal ◽

Abhilasha Jarori ◽

James P Walsh

Keyword(s):

Risk Factors ◽

Medical Center ◽

Tertiary Care ◽

Tertiary Care Medical Center

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Validation of semiautomated surgical site infection surveillance using electronic screening algorithms in 38 surgery categories

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.116 ◽

2018 ◽

Vol 39 (8) ◽

pp. 931-935 ◽

Cited By ~ 5

Author(s):

Sun Young Cho ◽

Doo Ryeon Chung ◽

Jong Rim Choi ◽

Doo Mi Kim ◽

Si-Ho Kim ◽

...

Keyword(s):

Surgical Site Infection ◽

Surveillance System ◽

Chart Review ◽

Medical Center ◽

Tertiary Care ◽

Microbial Culture ◽

Site Infection ◽

Electronic Screening ◽

Sensitivity Specificity ◽

Infection Preventionists

ObjectiveTo verify the validity of a semiautomated surgical site infection (SSI) surveillance system using electronic screening algorithms in 38 categories of surgery.DesignA cohort study for validation of semiautomated SSI surveillance system using screening algorithms.SettingA 1,989-bed tertiary-care referral center in Seoul, Republic of Korea.MethodsA dataset of 40,516 surgical procedures in 38 categories stored in the conventional SSI surveillance registry at the Samsung Medical Center between January 2013 and December 2014 was used as the reference standard. In the semiautomated surveillance system, electronic screening algorithms flagged cases meeting at least 1 of 3 criteria: antibiotic prescription, microbial culture, and infectious disease consultation. Flagged cases were audited by infection preventionists. Analyses of sensitivity, specificity, and positive predictive value (PPV) were conducted for the semiautomated surveillance system, and its effect on reducing the workload for chart review was evaluated.ResultsA total of 575 SSI events (1·42%) were identified by conventional SSI surveillance. The sensitivity of the semiautomated SSI surveillance was 96·7%, and the PPV of the screening algorithms alone was 4·1%. Semiautomated SSI surveillance reduced the chart review workload of the infection preventionists from 1,283 to 482 person hours per year (a 62·4% decrease).ConclusionsCompared to conventional surveillance, semiautomated surveillance using electronic screening algorithms followed by chart review of selected cases can provide high-validity surveillance results and can significantly reduce the workload of infection preventionists.

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Imipenem Resistance Among Pseudomonas aeruginosa Isolates Risk Factors for Infection and Impact of Resistance on Clinical and Economic Outcomes

Infection Control and Hospital Epidemiology ◽

10.1086/507274 ◽

2006 ◽

Vol 27 (9) ◽

pp. 893-900 ◽

Cited By ~ 106

Author(s):

Ebbing Lautenbach ◽

Mark G. Weiner ◽

Irving Nachamkin ◽

Warren B. Bilker ◽

Angela Sheridan ◽

...

Keyword(s):

Risk Factors ◽

Pseudomonas Aeruginosa ◽

Medical Center ◽

Tertiary Care ◽

Economic Outcomes ◽

Control Group ◽

Case Group ◽

Tertiary Care Medical Center ◽

Imipenem Resistance ◽

The Impact

Objectives.To identify risk factors for infection with imipenem-resistant Pseudomonas aeruginosa and determine the impact of imipenem resistance on clinical and economic outcomes among patients infected with P. aeruginosa.Designs.An ecologic study, a case-control study, and a retrospective cohort study.Setting.A 625-bed tertiary care medical center.Patients.All patients who had an inpatient clinical culture positive for P. aeruginosa between January 1, 1999, and December 31, 2000.Results.From 1991 through 2000, the annual prevalence of imipenem resistance among P. aeruginosa isolates increased significantly (P<.001 by the χ2 test for trend). Among 879 patients infected with P. aeruginosa during 1999-2000, a total of 142 had imipenem-resistant P. aeruginosa infection (the case group), whereas 737 had imipenem-susceptible P. aeruginosa infection (the control group). The only independent risk factor for imipenem-resistant P. aeruginosa infection was prior fluoroquinolone use (adjusted odds ratio, 2.52 [95% confidence interval {CI}, 1.61-3.92]; P<.001). Compared with patients infected with imipenem-susceptible P. aeruginosa, patients infected with imipenem-resistant P. aeruginosa had longer subsequent hospitalization durations (15.5 days vs 9 days; P = .02) and greater hospital costs ($81,330 vs $48,381; P<.001). The mortality rate among patients infected with imipenem-resistant P. aeruginosa was 31.1%, compared with 16.7% for patients infected with imipenem-susceptible P. aeruginosa (relative risk, 1.86 [95% CI, 1.38-2.51]; P<.001). In multivariable analyses, there remained an independent association between infection with imipenem-resistant P. aeruginosa and mortality.Conclusions.The prevalence of imipenem resistance among P. aeruginosa strains has increased markedly in recent years and has had a significant impact on both clinical and economic outcomes. Our results suggest that curtailing use of other antibiotics (particularly fluoroquinolones) may be important in attempts to curb further emergence of imipenem resistance.

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Surgical site infection after cesarean delivery: incidence and risk factors at an academic institution

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2017.08.025 ◽

2017 ◽

Vol 217 (6) ◽

pp. 735

Author(s):

Munoz JL ◽

Moulton L ◽

Lachiewicz M ◽

Liu X ◽

Goje O

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Cesarean Delivery ◽

Academic Institution ◽

Site Infection

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PGI1 PREVALENCE AND RISK FACTORS FOR DIARRHEA AT A LARGE TERTIARY CARE MEDICAL CENTER

Value in Health ◽

10.1016/s1098-3015(10)62990-7 ◽

2005 ◽

Vol 8 (3) ◽

pp. 369-370

Author(s):

S Kachroo ◽

N Kumar ◽

G Graham ◽

L Gerard ◽

T Dao ◽

...

Keyword(s):

Risk Factors ◽

Medical Center ◽

Tertiary Care ◽

Tertiary Care Medical Center ◽

Large Tertiary Care

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Developing a Risk Stratification Model for Surgical Site Infection after Abdominal Hysterectomy

Infection Control and Hospital Epidemiology ◽

10.1086/606166 ◽

2009 ◽

Vol 30 (11) ◽

pp. 1077-1083 ◽

Cited By ~ 47

Author(s):

Margaret A. Olsen ◽

James Higham-Kessler ◽

Deborah S. Yokoe ◽

Anne M. Butler ◽

Johanna Vostok ◽

...

Keyword(s):

Risk Factors ◽

Health Insurance ◽

Blood Transfusion ◽

Risk Stratification ◽

Surgical Site Infection ◽

Private Health Insurance ◽

Abdominal Hysterectomy ◽

Site Infection ◽

Independent Risk Factors ◽

Duration Of Operation

Objective.The incidence of surgical site infection (SSI) after hysterectomy ranges widely from 2% to 21%. A specific risk stratification index could help to predict more accurately the risk of incisional SSI following abdominal hysterectomy and would help determine the reasons for the wide range of reported SSI rates in individual studies. To increase our understanding of the risk factors needed to build a specific risk stratification index, we performed a retrospective multihospital analysis of risk factors for SSI after abdominal hysterectomy.Methods.Retrospective case-control study of 545 abdominal and 275 vaginal hysterectomies from July 1, 2003, to June 30, 2005, at 4 institutions. SSIs were defined by using Centers for Disease Control and Prevention/National Nosocomial Infections Surveillance criteria. Independent risk factors for abdominal hysterectomy were identified by using logistic regression.Results.There were 13 deep incisional, 53 superficial incisional, and 18 organ-space SSIs after abdominal hysterectomy and 14 organ-space SSIs after vaginal hysterectomy. Because risk factors for organ-space SSI were different according to univariate analysis, we focused further analyses on incisional SSI after abdominal hysterectomy. The maximum serum glucose level within 5 days after operation was highest in patients with deep incisional SSI, lower in patients with superficial incisional SSI, and lowest in uninfected patients (median, 189, 156, and 141 mg/dL, respectively; P = .005). Independent risk factors for incisional SSI included blood transfusion (odds ratio [OR], 2.4) and morbid obesity (body mass index [BMI], >35; OR, 5.7). Duration of operation greater than the 75th percentile (OR, 1.7), obesity (BMI, 30–35; OR, 3.0), and lack of private health insurance (OR, 1.7) were marginally associated with increased odds of SSI.Conclusions.Incisional SSI after abdominal hysterectomy was associated with increased BMI and blood transfusion. Longer duration of operation and lack of private health insurance were marginally associated with SSI.

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