192: Clinical risk factors for post-cesarean surgical site infection despite pre-incision azithromycin-based extended spectrum antibiotic prophylaxis

Objective.To identify risk factors associated with surgical site infection (SSI) after pediatric posterior spinal fusion procedure by examining characteristics related to the patient, the surgical procedure, and tissue hypoxia.Design.Retrospective case-control study nested in a hospital cohort study.Setting.A 475-bed, tertiary care children's hospital.Methods.All patients who underwent a spinal fusion procedure during the period from January 1995 through December 2006 were included. SSI cases were identified by means of prospective surveillance using National Nosocomial Infection Surveillance system definitions. Forty-four case patients who underwent a posterior spinal fusion procedure and developed an SSI were identified and evaluated. Each case patient was matched (on the basis of date of surgery, ± 3 months) to 3 control patients who underwent a posterior spinal fusion procedure but did not develop an SSI. Risk factors for SSI were evaluated by univariate analysis and multivariable conditional logistic regression. Odds ratios (ORs), with 95% confidence intervals (CIs) andPvalues, were calculated.Results.From 1995 to 2006, the mean annual rate of SSI after posterior spinal fusion procedure was 4.4% (range, 1.1%—6.7%). Significant risk factors associated with SSI in the univariate analysis included the following: a body mass index (BMI) greater than the 95th percentile (OR, 3.5 [95% CI, 1.5–8.3]); antibiotic prophylaxis with clindamycin, compared with other antibiotics (OR, 3.5 [95% CI, 1.2 10.0]); inappropriately low dose of antibiotic (OR, 2.6 [95% CI, 1.0–6.6]); and a longer duration of hypothermia (ie, a core body temperature of less than 35.5°C) during surgery (OR, 0.4 [95% CI, 0.2–0.9]). An American Society of Anesthesiologists (ASA) score of greater than 2, obesity (ie, a BMI greater than the 95th percentile), antibiotic prophylaxis with clindamycin, and hypothermia were statistically significant in the multivariable model.Conclusion.An ASA score greater than 2, obesity, and antibiotic prophylaxis with clindamycin were independent risk factors for SSI. Hypothermia during surgery appears to provide protection against SSI in this patient population.

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Nosocomial Outbreak of VIM-1-Producing Klebsiella pneumoniae Isolates of Multilocus Sequence Type 15: Molecular Basis, Clinical Risk Factors, and Outcome

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.05036-11 ◽

2011 ◽

Vol 56 (1) ◽

pp. 420-427 ◽

Cited By ~ 57

Author(s):

Isabel Sánchez-Romero ◽

Ángel Asensio ◽

Jesús Oteo ◽

María Muñoz-Algarra ◽

Beatriz Isidoro ◽

...

Keyword(s):

Risk Factors ◽

Klebsiella Pneumoniae ◽

Molecular Basis ◽

Hospital Setting ◽

Sequence Type ◽

Clinical Risk Factors ◽

High Rate ◽

Content Type ◽

Clinical Risk ◽

Extended Spectrum

ABSTRACTWe study the epidemiology, molecular basis, clinical risk factors, and outcome involved in the clonal dissemination of VIM-1-producingKlebsiella pneumoniaeisolates in the hospital setting. All patients infected/colonized by carbapenem-nonsusceptibleK. pneumoniae(CNSKP) in 2009 were included. Molecular epidemiology was studied by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Antibiotic resistance genes were analyzed by PCR and sequencing. Plasmids were studied by PFGE with S1 nuclease digestion and for incompatibility group by a PCR-based replicon typing scheme. Risk factors associated with CNSKP colonization/infection were assessed by an observational case-control study. All 55 patients studied were infected (n= 28) or colonized (n= 27) by VIM-1-producingK. pneumoniae. All but one acquired isolates of a single clone (PFGE cluster 1 [C1], sequence type 15 [ST15]), while another clone (PFGE C2, ST340) was detected in four patients. C1 isolates also produced the new extended-spectrum β-lactamase SHV-134.blaVIM-1was carried in a class 1 integron and an untypeable plasmid of ∼50 bp. The number of days that the patient received mechanical ventilation, the use of parenteral nutrition, previous treatment with linezolid, and treatment with extended-spectrum cephalosporins for more than 7 days were detected to be independent risk factors for CNSKP acquisition. The VIM-1-producingK. pneumoniaeST15 clone has a high capacity to spread among intensive care unit patients with severe underlying conditions. A high rate of associated mortality and great difficulty in controlling the spread of this clone, without permanent behavioral changes in the personnel, were observed.

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Surgical site infection with extended-spectrum β-lactamase-producing Enterobacteriaceae after cardiac surgery: incidence and risk factors

Clinical Microbiology and Infection ◽

10.1016/j.cmi.2017.07.004 ◽

2018 ◽

Vol 24 (3) ◽

pp. 283-288 ◽

Cited By ~ 1

Author(s):

S. Jolivet ◽

F.-X. Lescure ◽

L. Armand-Lefevre ◽

R. Raffoul ◽

M.-P. Dilly ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Surgical Site Infection ◽

Site Infection ◽

Extended Spectrum ◽

Surgery Incidence

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Study the Results of Antibiotic Prophylactic Protocol Adopted by Ain Shams University Hospitals for reducing the Risk of Surgical Site Infection in Patients undergoing Hip Arthroplasty, Pilot Study

QJM ◽

10.1093/qjmed/hcab104.005 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

El Zaher Hassan El Zaher ◽

Shady Samir ◽

Ahmed Mohamed Khaled ◽

Ahmed Mohamed Abdel Rahman Mohamed Farrage

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Hip Arthroplasty ◽

Joint Infection ◽

Site Infection ◽

University Hospitals ◽

Increased Risk ◽

Significant Difference ◽

Primary Hip Arthroplasty

Abstract Background Total hip arthroplasties are well-proven solutions in case of end-stage osteoarthritis of the hip joint. Although, presence of complications can be devastating for the patient, especially periprosthetic joint infection (PJI). To prevent PJI, antibiotic prophylaxis regimens are regularly used. Objectives To study the association of antibiotic choice, duration and dosage with prevalence of surgical site infection among patients with hip arthroplasty and identify risk factors for surgical site infection in patient with hip arthroplasty. Patients and Methods After obtaining the hospitals Research/Ethics Committee approval and written informed consents from the patients, this study was carried on. 30 patients with primary hip arthroplasty surgery and all operations were performed by senior staff members. All patients were screened for suitability by detailed clinical assessment of their history and physical examination as well as radiological investigations. Results The result of this study was that we have 2 cases infected from 30 cases with percent of infection among patient with primary hip arthroplasty is 6.7% and by studying the risk factors for infection there was no specific risk factor for infection except for patient with cardiac disease have increased risk of infection. Conclusion In conclusion, this study postulated that systemic antibiotic prophylaxis delivered preoperatively in primary THA procedures significantly reduces the incidence of infection. There is no significant difference in the efficacy of cephalosporins compared with that of quinolones. Prophylactic antibiotics should be taken IV before skin incision by 30-60 minutes and no need for antibiotics more than 24 hours after operation.

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Compliance With a Protocol for Intrapartum Antibiotic Prophylaxis Against Neonatal Group B Streptococcal Sepsis in Women With Clinical Risk Factors

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/s1064744902000261 ◽

2002 ◽

Vol 10 (4) ◽

pp. 223-229 ◽

Cited By ~ 3

Author(s):

Toni R. Sanders ◽

Christine L. Roberts ◽

Gwendolyn L. Gilbert

Keyword(s):

Risk Factors ◽

Antibiotic Prophylaxis ◽

Clinical Risk Factors ◽

Chart Audit ◽

Clinical Risk ◽

Intrapartum Antibiotic Prophylaxis ◽

Related Risk ◽

Neonatal Group ◽

Intrapartum Antibiotic ◽

Group B

Objective:The aim of this study was to determine the prevalence of clinical risk factors (CRF) for neonatal sepsis in laboring women and to evaluate clinician compliance with a CRF-based protocol for intrapartum antibiotic prophylaxis (IAP).Methods:A retrospective chart audit was undertaken at a district hospital (A) and a tertiary obstetric hospital (B) in Sydney, Australia between 1996 and 1998, to determine compliance with IAP in women with defined CRF.Results:Eighty-five (12%) women at Hospital A and 117 (19%) at Hospital B had one or more CRF. Overall compliance rates with the IAP protocols were 65 and 50%at Hospitals A and B respectively, but varied according to maternal, obstetric and sepsis-related risk factors. We postulate that differences between the hospitals were related to protocol implementation.Conclusions: Compliance with a CRF-based protocol was lower than previously reported. Improvements in protocol development, implementation and maintenance are required to enhance compliance with IAP based on CRF.

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Clinical Risk Factors for Extended Spectrum B-lactamase-producing Bacteriuria in Children with Myelodysplasia Performing Clean Intermittent Catheterization

Journal of Urological Surgery ◽

10.4274/jus.galenos.2020.2893 ◽

2020 ◽

Vol 7 (2) ◽

pp. 139-143

Author(s):

Tuncay Toprak ◽

Ahmet Şahan ◽

Muhammed Sulukaya ◽

Asgar Garayev ◽

Çağrı Akın Şekerci ◽

...

Keyword(s):

Risk Factors ◽

Clinical Risk Factors ◽

Intermittent Catheterization ◽

Clean Intermittent Catheterization ◽

Clinical Risk ◽

Extended Spectrum

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Prevention of early onset GBS sepsis: Impact of intrapartum antibiotic prophylaxis based on clinical risk factors

American Journal of Obstetrics and Gynecology ◽

10.1016/s0002-9378(97)80103-2 ◽

1997 ◽

Vol 176 (1) ◽

pp. S15

Author(s):

BV Brock ◽

DH Watts ◽

J Sobeck ◽

P Gill ◽

TJ Benedetti

Keyword(s):

Risk Factors ◽

Antibiotic Prophylaxis ◽

Early Onset ◽

Clinical Risk Factors ◽

Clinical Risk ◽

Intrapartum Antibiotic Prophylaxis ◽

Intrapartum Antibiotic

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Surgical site infection following elective mesh repair of inguinal hernia: an analysis of risk factors

10.21203/rs.2.20847/v1 ◽

2020 ◽

Author(s):

Yeye Zhuo ◽

Xinxin Li ◽

Juntian Chen ◽

Qian Zhang ◽

De Cai

Keyword(s):

Risk Factors ◽

Inguinal Hernia ◽

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Mesh Repair ◽

Multivariate Analyses ◽

Current Smoker ◽

Open Approach ◽

Site Infection ◽

Lymphocyte Ratio

Abstract Background: Surgical site infection (SSI) is a complication of mesh repair of inguinal hernia (IH) with an increase in length of stay and costs. We investigated both controllable and non-controllable risk factors for SSI following elective mesh repair of IH. Methods: A retrospective analysis was conducted of 1177 adult patients who underwent elective mesh repair of IH (not receiving antibiotic prophylaxis) from January 2010 to September 2019. Demographics, surgical variables and laboratory data were extracted from the electronic medical records. Receiver operating characteristic (ROC) analysis was performed to determine the optimal threshold of continuous variables. Independent risk factors for SSI were identified by univariate and multivariate analyses. Results: In total, 647 open and 530 laparoscopic IH repairs were included. The overall SSI rate within 30 days after surgery was 3.2% (39/1342 hernias) in the absence of antibiotic prophylaxis. Both the preoperative neutrophil‐lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were negatively correlated with the postoperative period of SSI (r = -0.368, P = 0.021; r = -0.334, P = 0.038, respectively). On multivariate analyses, body mass index (BMI) > 24.6 kg/m 2 (odds ratio [OR], 1.152; 95% confidence interval [CI], 1.041-1.275), current smoker (OR, 4.226; 95% CI, 1.222-14.611), preoperative NLR > 1.97 (OR, 3.670; 95% CI, 1.675-8.041), and open approach (OR, 4.866; 95% CI, 1.877-12.618) were significantly related to postoperative SSI. Conclusion: The controllable risk factors (elevated BMI, current smoker) found out here may help to identify patients at high-risk of SSI, allowing targeted preventive measures. Preoperative NLR > 1.97 is a previous unrecorded predictor for SSI following elective mesh repair of IH. Further study is needed to ascertain the magnitude of their effect.

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Antibiotic prophylaxis in surgery

Current Surgical Guidelines ◽

10.1093/med/9780198794769.003.0019 ◽

2018 ◽

pp. 169-178

Author(s):

Abdullah Jibawi ◽

Mohamed Baguneid ◽

Arnab Bhowmick

Keyword(s):

Risk Factors ◽

Multidrug Resistance ◽

Nosocomial Infection ◽

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Prophylactic Antibiotics ◽

Penicillin Allergy ◽

Site Infection ◽

Beta Lactams ◽

Common Cause

Surgical site infection (SSI) is a common cause of nosocomial infection and prophylactic antibiotics are used to reduce post-operative wound infection. To identify risk factors for developing SSIs and to prescribe antibiotics for both prophylactic and therapeutic treatment according to local guidelines is very important. Beta lactams should be avoided in case of penicillin allergy and risk of multidrug resistance. C. diff infection should be considered with prolonged use of antibiotics.

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