Risk factors related to surgical site infections among surgical patients in developing world: a systematic review

Globally, surgical site infections are one of the common infections which lead to a large amount of mortality and morbidity in postsurgical care. The risk for surgical site infection is multidimensional which includes mainly; patient, surgery, and hospital-related factors. This study is aimed to determine the burden of SSIs along with contributed risk factors. A prospective observational cross-sectional study was conducted in one of the largest public-sector hospitals in Pakistan. A total of 412 patients were recruited in the study with full consent and monitored for 30 days after surgery with direct and indirect surveillance. Overall, in seven different surgical procedures the incidence (29.8%) rate of SSI was observed; in appendectomy ( n = 17, 4.1%), exploratory laparotomy ( n = 51, 12.6%), laparoscopic cholecystectomy ( n = 12, 2.90%), mesh repair ( n = 17, 4.01%), thyroidectomy (5, 1.2%), transurethral resection of the prostate ( n = 11, 2.6%), and transurethral resection of the bladder (10, 2.4%). The average SSI rate in every single procedure was about 18 (4.27%) per surgical procedure out of 123 (29.85%) SSI cases. Types of SSI identified were superficial, deep incisional and organ/space ( n = 76, 18.4%, n = 23, 5.5%, and n = 24, 5.7%). Incidence of SSIs during admission, at readmission, and post-surveillance cases were ( n = 50, 12.1%, n = 25, 6.0% and n = 48, 11.6%). Associated risk factors found contributed to the incidence of SSI ( p < 0.05). Pre-operative ( n = 348, 84.5%) and 6 (1.5%) surgical patients did not received the post-operative antibiotics. The P. aeruginosa ( n = 15, 12.1%) and S. aureus (13, 10.5%). Cefoperazone and sulbactam were the most prescribed antibiotics. Associated risk factors and treatment outcomes of surgical patients have a direct association with the incidence of SSI. Hospital-based antimicrobial stewardship, implementation of surgical guidelines, patient care, and education are needed to develop at wards level in hospitals.

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Risk Factors for Cesarean Section Surgical Site Infections: A Systematic Review

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1009 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s377-s377

Author(s):

Feah Visan ◽

Jenalyn Castro ◽

Yousra Siam Shahada ◽

Naser Al Ansari ◽

Almunzer Zakaria

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Body Mass Index ◽

Risk Factor ◽

Cesarean Section ◽

Surgical Site Infection ◽

Body Mass ◽

Surgical Site Infections ◽

Site Infection ◽

Inclusion Criteria

Background: According to the CDC NHSN, surgical site infections (SSI) are wound infections that develop within 30 days postoperatively for nonimplanted surgeries such as cesarean sections. SSIs is shown to manifest in a continuum of a purulent discharge from surgical site to severe sepsis. It contributes to rising morbidity, mortality and prolonged length of stay. Objective: To describe risk factors to the development of SSI in cesarean section in descriptive studies. Methods: The Preferred Reporting Items for Systematic Reviews (PRISMA) reporting guidelines is used as method for this systematic review. A PubMed literature search was conducted, limited to published articles in English from 1998 to 2016 using the broad key terms “cesarean section,” “surgical site infection,” and “risk factor.” The following inclusion criteria were applied to all reviews: (1) peer-reviewed journal, (2) computed risk factor for SSI development, and (3) calculated SSI rate. Reviews of references of the include studies were conducted, and 7 studies were appraised, with only 1 accepted. Results: After extracting data from 52 article reviews, 23 were finally accepted based on the inclusion criteria. Most studies were multivariate studies (n = 8) followed by cohort studies (n = 6). Unique numerators and denominators for SSI reviews were mentioned in all 23 studies, of which 22 studies followed the CDC NHSN definitions for SSI. Within the 23 studies, most studies showed that obesity (11.46%) is a common maternal risk factor for the development of postoperative cesarean section SSI. Conclusions: Identifying that obesity is a major contributor of surgical site infection in postoperative cesarean section women is a topic that warrants exploration. The relationship of cesarean section SSI to obesity should be investigated, specifically highlighting the level of obesity based on the WHO international body mass index (BMI) classification and the development of SSI. A correlation between increasing wound infection rates and increasing body mass index should be studied further. Published recommendations for preventing SSIs in this population should be reviewed.Funding: NoneDisclosures: None

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Epidemiology and Risk Factors of Post Operative Site Infections in Surgical Patients: A Systematic Review

Archives Of Pharmacy Practice ◽

10.51847/zoixqqgvc6 ◽

2022 ◽

Vol 13 (1) ◽

pp. 31-36

Author(s):

Mohammad Salahuddin ◽

Farahnaz Muddebihal ◽

Ashokkumar Thirunavukkarasu ◽

Abdulhadi Abdullah Z Alanazi ◽

Ahmed Mutiq Subayyil Alrashdi ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Surgical Patients ◽

Operative Site

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Prevalence of Nosocomial Infections After Surgery in Greek Hospitals: Results of Two Nationwide Surveys

Infection Control and Hospital Epidemiology ◽

10.1086/502399 ◽

2004 ◽

Vol 25 (4) ◽

pp. 319-324 ◽

Cited By ~ 14

Author(s):

Achilleas Gikas ◽

Maria Roumbelaki ◽

John Pediaditis ◽

Pavlos Nikolaidis ◽

Stamatina Levidiotou ◽

...

Keyword(s):

Risk Factors ◽

Nosocomial Infections ◽

Prophylactic Antibiotic ◽

Surgical Site Infections ◽

Antibiotic Use ◽

Developed Countries ◽

Surgical Patients ◽

Prevalence Studies ◽

Day Range ◽

Greek Hospitals

AbstractObjective:To determine the frequency and type of nosocomial infections (NIs) (especially surgical-site infections [SSIs]), risk factors, and the type and duration of antibiotic use among surgical patients in Greek hospitals.Design:Two point-prevalence studies.Setting:Fourteen Greek hospitals.Patients:Those in the hospitals during two prevalence surveys undergoing surgery during their stay.Results:In the 1999 survey, 129 of 1,037 surgical patients had developed 148 NIs (14.3%). A total of 1,093 operations were registered, and 49 SSIs (4.5%) were found. In the 2000 survey, 82 of 868 surgical patients had developed 88 NIs (10.1%). A total of 902 operations were registered, and 38 SSIs were detected (4.2%). The median length of stay (LOS) for surgical patients without SSI was 10.0 days (range, 1-19 days); for patients who developed SSI it was 30 days (range, 1-52 days; P < .001). The median LOS prior to surgery for patients without SSI was 1 day (range, 0-4 days); for patients who developed SSI it was 3 days (range, 0-7.5 days; P < .001). Among 30 possible risk factors studied, wound class, LOS prior to surgery, and central venous catheterization were independent predictors of SSI. Median durations of prophylactic antibiotic therapy were 4 days (range, 1-14 days) and 6 days (range, 1-16 days) in the 1999 and 2000 surveys, respectively.Conclusion:Surgical patients in Greek hospitals suffered higher rates of SSI than did surgical patients in other developed countries while prophylactic antibiotics were used excessively.

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Wound infection in surgery department in BSMMU: A study of 100 cases

Journal of the Bangladesh Society of Anaesthesiologists ◽

10.3329/jbsa.v24i2.19804 ◽

2014 ◽

Vol 24 (2) ◽

pp. 65-69

Author(s):

M Nur-e-elahi ◽

I Jahan ◽

O Siddiqui ◽

SU Ahmed ◽

AI Joarder ◽

...

Keyword(s):

Risk Factors ◽

Wound Infection ◽

Elective Surgery ◽

Surgical Site Infections ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Surgical Patients ◽

Resistance Pattern ◽

Degree Of Contamination ◽

Surgery Department

Background Surgical site infections (SSI) are the most common nosocomial infection in surgical patients, accounting for 38% of all such infections, and are a significant source of postoperative morbidity resulting in increased hospital length of stay and increased cost. Objectives To find out the incidence of wound infection in patients following elective surgery and the most likely causative organisms and their resistance pattern. Methods Prospective data were collected on 496 surgical patients admitted in the surgery department in BSMMU from January 2010 to June 2010. All preoperative risk factors were evaluated. Patients operated were followed in the post operative period and if any wound infection noted, swab from the site of infection was sent for culture and sensitivity and antibiotics were given accordingly. Results Following 496 elective operations 20.16 % patients developed wound infection. Highest numbers of infection were seen in the fifth decade with slight female preponderance. Wound infection progressively rises with the degree of contamination and increasing operative time. The common risk factors for development of surgical wound infection were anemia (52%), malnutrition (44%), diabetes (38%), jaundice (30%), contaminated operation (44%) dirty operation (38 %), obesity and smoking. The most predominant isolated organism was Escherichia coli (43%) followed by Staphylococcus aureus (33%) and Pseudomonas aeruginosa (11%). Ceftriaxone still remains the most effective antibiotic although the incidence of resistance is rising. Conclusion Despite a good numbers of variables influence surgical site infections; it is still possible to reduce the infection rate by correcting modifiable risk factors, reducing degree of contamination and duration of operation. To battle the emerging resistance of pathogens a definitive guideline is essential. DOI: http://dx.doi.org/10.3329/jbsa.v24i2.19804 Journal of Bangladesh Society of Anaesthesiologists 2011; 24(2): 65-69

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Incidence, risk factors, and outcomes of early postoperative hyperglycemia in surgical patients: a protocol for a systematic review and meta-analysis

Systematic Reviews ◽

10.1186/s13643-020-01416-4 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Paddy Ssentongo ◽

Joseph A. Lewcun ◽

Anna E. Ssentongo ◽

David I. Soybel

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Cohort Studies ◽

Clinical Outcomes ◽

Meta Analysis ◽

Geographical Location ◽

Risk Of Bias ◽

Postoperative Outcomes ◽

Surgical Patients ◽

Incidence Risk

Abstract Background Early postoperative hyperglycemia (POHG) is common and associated with poor postoperative outcomes. Currently, there is no systematic review and meta-analysis that addresses the knowledge gap of the incidence of POHG in surgical patients and that explores the associated risk factors and complications. The objective of this study will be to estimate the pooled incidence, risk factors, and clinical outcomes of early postoperative hyperglycemia in men and women globally. Methods We designed and registered a study protocol for a systematic review and meta-analysis of studies reporting the incidence of postoperative hyperglycemia (POHG). We will search PubMed (MEDLINE), Scopus, Web of Science, EMBASE, Cochrane Library, OVID (HEALTH STAR), OVID (MEDLINE), and Joana Briggs Institute EBF Database (from inception onwards). Randomized controlled trials and observational cohort studies reporting the incidence of POHG and conducted in surgical patients will be included. No age, geographical location, study design, or language limits will be applied. The primary outcome will be the incidence of POHG. Secondary outcomes will be risk factors and clinical outcomes of POHG. Two reviewers will independently screen citations, full text articles, and abstract data, extract data, and evaluate the quality and bias of included studies. Discrepancies will be resolved through discussion or consultation with a third researcher. The risk of bias and study methodological quality of included studies will be evaluated by the appropriate Cochrane risk of bias tool for randomized trials and Newcastle-Ottawa Scale for cohort studies. If feasible, we will conduct random effects meta-analysis with a logit transformation of proportions. We will report the probability of postoperative hyperglycemia as a measure of incidence rate, relative risk ratios (RR), and 95% confidence intervals to report the effects of the risk factors and postoperative outcomes. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., age, gender, geographical location, publication year, comorbidities, type of surgical procedure). The Egger test and funnel plots will be used to assess small study effects (publication bias). Discussion This systematic review and meta-analysis will identify, evaluate, and integrate the evidence on the incidence, risk factors, and outcomes of early POHG in surgical patients. The results of this study can be used to identify populations which may be at particular risk for POHG. Future studies which use this information to better guide post-operative glycemic control in surgical patients could be considered. Systematic review registration PROSPERO registration number CRD42020167138

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