Patients with Risk Factors for Complications Do Not Require Longer Antimicrobial Therapy for Complicated Intra-Abdominal Infection

A prospective, multicenter, randomized controlled trial found that four days of antibiotics for source-controlled complicated intra-abdominal infection resulted in similar outcomes when compared with a longer duration. We hypothesized that patients with specific risk factors for complications also had similar outcomes. Short-course patients with obesity, diabetes, or Acute Physiology and Chronic Health Evaluation II ≥15 from the STOP-IT trial were compared with longer duration patients. Outcomes included incidence of and days to infectious complications, mortality, and length of stay. Obese and diabetic patients had similar incidences of and days to surgical site infection, recurrent intra-abdominal infection, extra-abdominal infection, and Clostridium difficile infection. Short- and long-course patients had similar incidences of complications among patients with Acute Physiology and Chronic Health Evaluation II ≥15. However, there were fewer days to the diagnosis of surgical site infection (9.5 ± 3.4 vs 21.6 ± 6.2, P = 0.010) and extra-abdominal infection (12.4 ± 6.9 vs 21.8 ± 6.1, P = 0.029) in the short-course group. Mortality and length of stay was similar for all groups. A short course of antibiotics in complicated intraabdominal infection with source control seems to have similar outcomes to a longer course in patients with diabetes, obesity, or increased severity of illness.

Download Full-text

1247. Multicenter Study on Risk Factors for Surgical Site Infection After Exploratory Laparotomy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1110 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S449-S449

Author(s):

Túlio Alves Jeangregório Rodrigues ◽

Guilherme Fernandes de Oliveira ◽

Júlia G C Dias ◽

Laís Souza Campos ◽

Letícia Rodrigues ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Abdominal Surgery ◽

Surgical Site Infection ◽

Exploratory Laparotomy ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Hospital Death ◽

Site Infection ◽

The Impact

Abstract Background Exploratory laparotomy surgery is abdominal operations not involving the gastrointestinal tract or biliary system. The objective of our study is to answer three questions: (a) What is the risk of surgical site infection (SSI) after exploratory abdominal surgery? (b) What is the impact of SSI in the hospital length of stay and hospital mortality? (c) What are risk factors for SSI after exploratory abdominal surgery? Methods A retrospective cohort study assessed meningitis and risk factors in patients undergoing exploratory laparotomy between January 2013 and December 2017 from 12 hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the National Healthcare Safety Network (NHSN)/CDC procedure-associated protocols for routine SSI surveillance. 26 preoperative and operative categorical and continuous variables were evaluated by univariate and multivariate analysis (logistic regression). Outcome variables: Surgical site infection (SSI), hospital death, hospital length of stay. Variables were analyzed using Epi Info and applying statistical two-tailed test hypothesis with significance level of 5%. Results A sample of 6,591 patients submitted to exploratory laparotomy was analyzed (SSI risk = 4.3%): Hospital length of stay in noninfected patients (days): mean = 16, median = 6, std. dev. = 30; hospital stay in infected patients: mean = 32, median = 22, std. dev. = 30 (P < 0.001). The mortality rate in patients without infection was 14% while hospital death of infected patients was 20% (P = 0.009). Main risk factors for SSI: ügeneral anesthesia (SSI = 4.9%, relative risk – RR = 2.8, P < 0.001); preoperative hospital length of stay more than 4 days (SSI=3.9%, RR=1.8, P = 0.003); wound class contaminated or dirty (SSI = 5.4%, RR = 1.5, P = 0.002); duration of procedure higher than 3 hours (SSI = 7.1%, RR = 2.1, P < 0.001); after trauma laparotomy (SSI = 7.8%, RR = 1.9, P = 0.001). Conclusion We identified patients at high risk of surgical site infection after exploratory laparotomy: trauma patients from contaminated or dirty wound surgery, submitted to a procedure with general anesthesia that last more than 3 hours have 13% SSI. Patients without any of these four risk factors have only 1.2% SSI. Disclosures All authors: No reported disclosures.

Download Full-text

Coronavirus Disease 2019 ICU Patients Have Higher-Than-Expected Acute Physiology and Chronic Health Evaluation–Adjusted Mortality and Length of Stay Than Viral Pneumonia ICU Patients

Critical Care Medicine ◽

10.1097/ccm.0000000000005012 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Thomas L. Higgins ◽

Maureen M. Stark ◽

Kathy N. Henson ◽

Laura Freeseman-Freeman

Keyword(s):

Length Of Stay ◽

Viral Pneumonia ◽

Chronic Health Evaluation ◽

Health Evaluation ◽

Icu Patients ◽

Chronic Health

Download Full-text

Surgical Site Infection After Emergency Abdominal Surgery in China: A Multicenter Prospective Study

10.21203/rs.3.rs-33387/v1 ◽

2020 ◽

Author(s):

Ze Li ◽

Hui Li ◽

Pin Lv ◽

Xingang Peng ◽

Changliang Wu ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Length Of Stay ◽

Abdominal Surgery ◽

Surgical Site Infection ◽

Secondary Outcome ◽

Microbial Culture ◽

Site Infection ◽

High Blood Glucose ◽

Emergency Abdominal Surgery

Abstract Background There is still a lack of relevant studies on surgical site infection (SSI) after emergency abdominal surgery (EAS) in China. This study aims to understand the status of SSI after EAS in China and discuss its risk factors. Materials and Methods All adult patients who underwent EAS in 47 hospitals in China from May 1 to 31, 2018, and from May 1 to June 7, 2019, were enrolled in this study. The basic information, perioperative data, and microbial culture results of infected incision were prospectively collected.The primary outcome measure was the incidence of SSI after EAS, and the secondary outcome variables were postoperative length of stay, ICU admission rate, ICU length of stay, 30-day postoperative mortality, and treatment costs. Univariate and multivariate logistic regression were used to analyze the risk factors.Results A total of 953 patients (age 48.8 ± 17.9 years, male 51.9%) with EAS were included in this study: 71 patients (7.5%) developed SSI after surgery.The main pathogen of SSI was Escherichia coli (culture positive rate 29.6%). Patients with SSI had significantly longer overall hospital (p < 0.001) and ICU stays (p < 0.001), significantly higher ICU admissions (p < 0.001), and medical costs (p < 0.001) than patients without SSI.Multivariate logistic regression analysis showed that male (P = 0.010), high blood glucose level (P < 0.001), colorectal surgery (P < 0.001), intestinal obstruction (P = 0.045) and surgical duration (P = 0.007) were risk factors for SSI, whereas laparoscopic surgery (P < 0.001 = 0.022) was a protective factor. Conclusion This study found a high incidence of SSI after EAS in China. The occurrence of SSI prolongs the patient's hospital stay and increases the medical burden. The study also revealed predictors of SSI after EAS and provides a basis for the development of norms for the prevention of surgical site infection after emergency abdominal surgery.

Download Full-text

Prospective multicenter study on the incidence of surgical site infection after emergency abdominal surgery in China

Scientific Reports ◽

10.1038/s41598-021-87392-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ze Li ◽

Hui Li ◽

Pin Lv ◽

Xingang Peng ◽

Changliang Wu ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Length Of Stay ◽

Abdominal Surgery ◽

Surgical Site Infection ◽

Secondary Outcome ◽

Site Infection ◽

Multivariate Logistic Regression ◽

High Blood Glucose ◽

Emergency Abdominal Surgery

AbstractThere is still a lack of relevant studies on surgical site infection (SSI) after emergency abdominal surgery (EAS) in China. This study aims to understand the incidence of SSI after EAS in China and discuss its risk factors. All adult patients who underwent EAS in 47 hospitals in China from May 1 to 31, 2018, and from May 1 to June 7, 2019, were enrolled in this study. The basic information, perioperative data, and microbial culture results of infected incision were prospectively collected. The primary outcome measure was the incidence of SSI after EAS, and the secondary outcome variables were postoperative length of stay, ICU admission rate, ICU length of stay, 30-day postoperative mortality, and hospitalization cost. Univariate and multivariate logistic regression were used to analyze the risk factors. The results were expressed as the odds ratio and 95% confidence interval. A total of 953 patients [age 48.8 (SD: 17.9), male 51.9%] with EAS were included in this study: 71 patients (7.5%) developed SSI after surgery. The main pathogen of SSI was Escherichia coli (culture positive rate 29.6%). Patients with SSI had significantly longer overall hospital (p < 0.001) and ICU stays (p < 0.001), significantly higher ICU admissions (p < 0.001), and medical costs (p < 0.001) than patients without SSI. Multivariate logistic regression analysis showed that male (P = 0.010), high blood glucose level (P < 0.001), colorectal surgery (P < 0.001), intestinal obstruction (P = 0.045) and surgical duration (P = 0.007) were risk factors for SSI, whereas laparoscopic surgery (P < 0.001) was a protective factor. This study found a high incidence of SSI after EAS in China. The occurrence of SSI prolongs the patient's hospital stay and increases the medical burden. The study also revealed predictors of SSI after EAS and provides a basis for the development of norms for the prevention of surgical site infection after emergency abdominal surgery.

Download Full-text

A comparison of Simplified Acute Physiology Score II, Acute Physiology and Chronic Health Evaluation II and Acute Physiology and Chronic Health Evaluation III scoring system in predicting mortality and length of stay at surgical intensive care unit

Nigerian Medical Journal ◽

10.4103/0300-1652.129651 ◽

2014 ◽

Vol 55 (2) ◽

pp. 144 ◽

Cited By ~ 18

Author(s):

MahryarTaghavi Gilani ◽

Majid Razavi ◽

AzadehMokhtari Azad

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Scoring System ◽

Simplified Acute Physiology Score ◽

Chronic Health Evaluation ◽

Surgical Intensive Care Unit ◽

Health Evaluation ◽

Surgical Intensive Care ◽

Chronic Health

Download Full-text

Surgical Site Infection: The Clinical and Economic Impact

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0038-1677002 ◽

2019 ◽

Vol 32 (03) ◽

pp. 157-165 ◽

Cited By ~ 7

Author(s):

Megan Turner ◽

John Migaly

Keyword(s):

Risk Factors ◽

Colorectal Surgery ◽

Length Of Stay ◽

Surgical Site Infection ◽

Economic Impact ◽

Financial Incentives ◽

Surgical Care ◽

Site Infection ◽

The Public

AbstractSurgical site infection (SSI) following colorectal surgery is associated with worse postoperative outcomes, longer length of stay, and higher rates of readmission. SSI rates have been established as a surrogate metric for the overall quality of surgical care and are intricately tied to financial incentives and the public reputation of an institution. While risk factors and prevention mechanisms for SSI are well established, the rates of SSI remain high. This article discusses the clinical and economic impact of SSI and strategies for mitigating the risk of SSI through bundled prevention practices.

Download Full-text