Benchmarking for surgical site infections among gastrointestinal surgeries and related risk factors: multicenter study in Kuwait

Wafaa S Hamza 1 2, Mona F Salama 1 3, Samar S Morsi 1 4, Naglaa M Abdo 1 5, Mariam A Al-Fadhli 1

Affiliations

09 March 2018

-

doi: 10.2147/IDR.S167213

Abstract

Purpose: To measure surgical site infection (SSI) rates among gastrointestinal surgeries and to identify the associated risk factors.

Patients and methods: We conducted a multicenter, retrospective, surveillance-based study of adults undergoing gastric, colon, and small bowel (SB) procedures from January to December 2016. Univariate and multivariate analyses were conducted to determine the predictive variables in each surgery.

Results: In total, 71 of 2,099 patients developed SSI - 0.8%, 19.8%, and 10.8% following gastric, colon, and SB surgeries, respectively. In gastric surgery, the risk factors identified by univariate analysis were age, duration, wound class, risk index, emergency, and scope use (P<0.05). Logistic regression analysis revealed that the laparoscopic approach was the only significant predictor, with an inverse relationship of SSI rate vs open gastric surgery (P<0.05). Prolonged duration was a significant risk factor for developing SSI in colon surgery, and emergency was a significant risk for development of SSI in SB surgery. Gram-negative bacilli were the main causative pathogens, with a high percentage of multidrug-resistant organisms.

Conclusion: Variances in SSI rates and risk factors among gastric, colon, and SB surgery were detected. The use of an endoscope in gastric surgeries exhibited a protective effect against the development of SSI. The reduction of the SSI rate can be achieved by targeted preventive interventions for the identified risk factors.

Keywords: Gram-negative bacilli; gastric surgery; health care-associated infections; laparoscope; post-discharge surveillance; surveillance.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Similar articles

Surgical site infection risk factors identified by multivariate analysis for patient undergoing laparoscopic, open colon, and gastric surgery.

Imai E, Ueda M, Kanao K, Kubota T, Hasegawa H, Omae K, Kitajima M.Am J Infect Control. 2008 Dec;36(10):727-31. doi: 10.1016/j.ajic.2007.12.011. Epub 2008 Oct 3.PMID: 18834730

Urgency of surgery as an indicator for the occurrence of surgical site infections: data from over 100,000 surgical procedures.

Aghdassi SJS, Schröder C, Gastmeier P.J Hosp Infect. 2021 Apr;110:1-6. doi: 10.1016/j.jhin.2020.12.017. Epub 2021 Jan 7.PMID: 33422591

The association between the increased performance of laparoscopic colon surgery and a reduced risk of surgical site infection.

Kagawa Y, Yamada D, Yamasaki M, Miyamoto A, Mizushima T, Yamabe K, Imazato M, Fukunaga H, Kobayashi S, Shimizu J, Umeshita K, Ito T, Doki Y, Mori M.Surg Today. 2019 Jun;49(6):474-481. doi: 10.1007/s00595-019-1760-1. Epub 2019 Jan 25.PMID: 30684051 Free PMC article.

Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance.

Konishi T, Watanabe T, Kishimoto J, Nagawa H.Ann Surg. 2006 Nov;244(5):758-63. doi: 10.1097/01.sla.0000219017.78611.49.PMID: 17060769 Free PMC article.

Differences in surgical site infection between laparoscopic colon and rectal surgeries: sub-analysis of a multicenter randomized controlled trial (Japan-Multinational Trial Organization PREV 07-01).

Goto S, Hasegawa S, Hata H, Yamaguchi T, Hida K, Nishitai R, Yamanokuchi S, Nomura A, Yamanaka T, Sakai Y.Int J Colorectal Dis. 2016 Nov;31(11):1775-1784. doi: 10.1007/s00384-016-2643-1. Epub 2016 Sep 7.PMID: 27604812 Clinical Trial.

Cited by

Ongoing Strategies to Improve Antimicrobial Utilization in Hospitals across the Middle East and North Africa (MENA): Findings and Implications.

Haseeb A, Saleem Z, Maqadmi AF, Allehyani RA, Mahrous AJ, Elrggal ME, Kamran SH, AlGethamy M, Naji AS, AlQarni A, Alhariqi KW, Khan MA, Ibrahim K, Raees F, Azmat A, Cook A, Campbell SM, Lorenzetti G, Meyer JC, Godman B, Moore CE.Antibiotics (Basel). 2023 Apr 28;12(5):827. doi: 10.3390/antibiotics12050827.PMID: 37237730 Free PMC article.

Emerging Status of Multidrug-Resistant Bacteria and Fungi in the Arabian Peninsula.

Borgio JF, Rasdan AS, Sonbol B, Alhamid G, Almandil NB, AbdulAzeez S.Biology (Basel). 2021 Nov 6;10(11):1144. doi: 10.3390/biology10111144.PMID: 34827138 Free PMC article. Review.

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

Li Z, Li H, Lv P, Peng X, Wu C, Ren J, Wang P.Sci Rep. 2021 Apr 8;11(1):7794. doi: 10.1038/s41598-021-87392-8.PMID: 33833359 Free PMC article.

Do antibacterial skin sutures reduce surgical site infections after elective open abdominal surgery? - Study protocol of a prospective, randomized controlled single center trial.

Matz D, Teuteberg S, Wiencierz A, Soysal SD, Heizmann O.Trials. 2019 Jul 2;20(1):390. doi: 10.1186/s13063-019-3492-3.PMID: 31266520 Free PMC article.

KMEL References

https://pubmed.ncbi.nlm.nih.gov/

References

  1.  
    1. Jeong SJ, Ann HW, Kim JK, et al. Incidence and risk factors for surgical site infection after gastric surgery: a multicenter prospective cohort study. Infect Chemother. 2013;45(4):422–430. - PMC - PubMed
  2.  
    1. Utsumi M, Shimizu J, Miyamoto A, et al. Age as an independent risk factor for surgical site infections in a large gastrointestinal surgery cohort in Japan. J Hosp Infect. 2010;75(3):183–187. - PubMed
  3.  
    1. National Healthcare Safety Network . Surgical Site Infection (SSI) Event. Centers for Disease Control and Prevention; Atlanta: 2013. [Accessed May, 2013]. Available from: http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrentPDF.
  4.  
    1. Surgical site infection (SSI) event [Accessed January 2017]. Available from: www.icdkwt.com/surveillance_out/ssi/KNHSSSSIprotocol2013.pdf.
  5.  
    1. NNIS System National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2003, issued August 2003. Am J Infect Control. 2003;31(8):481–498. - PubMed
  6.  
    1. Culver DH, Horan TC, Gaynes RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med. 1991;91(3):S152–S157. - PubMed
  7.  
    1. Nguyen NT, Goldman C, Rosenquist CJ, Wolfe BM, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234(3):279–291. - PMC - PubMed
  8.  
    1. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20(4):250–278. - PubMed
  9.  
    1. Lawson EH, Hall BL, Ko CY, Cy K. Risk factors for superficial vs deep/organ-space surgical site infections: implications for quality improvement initiatives. JAMA Surg. 2013;148(9):1–10. - PubMed
  10.  
    1. Gomila A, Carratalà J, Camprubí D, et al. Risk factors and outcomes of organ-space surgical site infections after elective colon and rectal surgery. Antimicrob Resist Infect Control. 2017;6:40. - PMC - PubMed
  11.  
    1. Tang R, Chen HH, Wang YL, et al. Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2,809 consecutive patients. Ann Surg. 2001;234(2):181–189. - PMC - PubMed
  12.  
    1. Endo Shunji, Tsujinaka Toshimasa, Fujitani Kazumasa, Fujita Junya, Tamura Shigeyuki, Yamasaki Makoto. Risk factors for superficial incisional surgical site infection after gastrectomy: analysis of patients enrolled in a prospective randomized trial comparing skin closure methods. Gastric Cancer. 2016;19:639–644. - PubMed
  13.  
    1. Smith RL, Bohl JK, Mcelearney ST, et al. Wound infection after elective colorectal resection. Ann Surg. 2004;239(5):599–607. - PMC - PubMed
  14.  
    1. de Oliveira AC, Carvalho DV. Evaluation of underreported surgical site infection evidenced by post-discharge surveillance. Rev Lat Am Enfermagem. 2007;15(5):992–997. - PubMed
  15.  
    1. Edwards JR, Peterson KD, Yi Mu BBA, et al. National Healthcare Safety Network (NHSN) report: Data summary for 2006 through 2008, issued December 2009 Atlanta, Georgia Published by the Association for Professionals in Infection Control and Epidemiology. Am J Infect Control. 2009;(37):783–805. - PubMed
  16.  
    1. Christou NV, Jarand J, Sylvestre JL, Mclean AP. Analysis of the incidence and risk factors for wound infections in open bariatric surgery. Obes Surg. 2004;14(1):16–22. - PubMed
  17.  
    1. Scott JD, Forrest A, Feuerstein S, Fitzpatrick P, Schentag JJ. Factors associated with postoperative infection. Infect Control Hosp Epidemiol. 2001;22(6):347–351. - PubMed
  18.  
    1. Kaye KS, Schmit K, Pieper C, et al. The effect of increasing age on the risk of surgical site infection. J Infect Dis. 2005;191(7):1056–1062. - PubMed
  19.  
    1. Cheng K, Li J, Kong Q, Wang C, Ye N, Xia G. Risk factors for surgical site infection in a teaching hospital: a prospective study of 1,138 patients. Patient Prefer Adherence. 2015;9:1171–1177. - PMC - PubMed
  20.  
    1. National Nosocomial Infections Surveillance System, National Noso-comial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004;32(8):470–485. - PubMed
  21.  
    1. Ishikawa K, Kusumi T, Hosokawa M, Nishida Y, Sumikawa S, Furukawa H. Incisional surgical site infection after elective open surgery for colorectal cancer. Int J Surg Oncol. 2014;2014:1–5. - PMC - PubMed
  22.  
    1. Hübner M, Diana M, Zanetti G, Eisenring MC, Demartines N, Troillet N. Surgical site infections in colon surgery: the patient, the procedure, the hospital, and the surgeon. Arch Surg. 2011;146(11):1240–1245. - PubMed
  23.  
    1. Young H, Knepper B, Moore EE, Johnson JL, Mehler P, Price CS. Surgical site infection after colon surgery: National Healthcare Safety Network risk factors and modeled rates compared with published risk factors and rates. J Am Coll Surg. 2012;214(5):852–859. - PubMed
  24.  
    1. Watanabe M, Suzuki H, Nomura S, et al. Performance assessment of the risk index category for surgical site infection after colorectal surgery. Surg Infect. 2015;16(1):84–89. - PubMed
  25.  
    1. Leong G, Wilson J, Charlett A. Duration of operation as a risk factor for surgical site infection: comparison of English and US data. J Hosp Infect. 2006;63(3):255–262. - PubMed
  26.  
    1. Ercole FF, Starling CE, Chianca TC, Carneiro M. Applicability of the national nosocomial infections surveillance system risk index for the prediction of surgical site infections: a review. Braz J Infect Dis. 2007;11(1):134–141. - PubMed
  27.  
    1. Imai E, Ueda M, Kanao K, et al. Surgical site infection risk factors identified by multivariate analysis for patient undergoing laparoscopic, open colon, and gastric surgery. Am J Infect Control. 2008;36(10):727–731. - PubMed
  28.  
    1. Sanabria A, Vega V, Dominguez LC, Espitia E, Serna A, Osorio C. The evolution of laparoscopy in abdominal surgery: a meta-analysis of the effect on infectious outcomes. Minim Invasive Ther Allied Technol. 2014;23(2):74–86. - PubMed
  29.  
    1. Fry DE, Fry Donald E. The prevention of surgical site infection in elective colon surgery. Scientifica. 2013;2013:1–19. - PMC - PubMed
  30.  
    1. Fusco Suzimar de Fátima Benato, Massarico Natiara Medolago, Martins Maria Virginia, Alves Faria Fadul, Castelo Carlos Magno, Fortaleza Branco, Pavan ÉrikaCibele Pereira, Palhares Valéria de Castilho, et al. Surgical site infection and its risk factors in colon surgeries. J School Nurs. 2016;50(1):43–49. - PubMed
  31.  
    1. Walz JM, Paterson CA, Seligowski JM, Heard SO. Surgical site infection following bowel surgery: a retrospective analysis of 1446 patients. Arch Surg. 2006;141(10):1014–1018. - PubMed
  32.  
    1. Fiorio M, Marvaso A, Viganò F, Marchetti F. Incidence of surgical site infections in general surgery in Italy. Infection. 2006;34(6):310–314. - PubMed
  33.  
    1. Sgebres Agelaw, Tiruneh M, Fentie M. Antimicrobial susceptibility patterns of bacterial isolates from patients with postoperative surgical site infection, health professionals and environmental samples at a tertiary level hospital, North West Ethiopia. Int J Pharm Sci Rev Res. 2013;3(1):1–9.
  34.  
    1. Dessie W, Gebrumulugeta, Surafael Fentaw A. MuluHassen, and EngidaAbebe. Pattern of Bacterial Pathogens and Their Susceptibility Isolated fromSurgical Site Infections at Selected Referral Hospitals, Addis Ababa, Ethiopia. Int J Microbiol. 2016;2016:1–8. - PMC - PubMed
  35.  
    1. Dessalegn Lopiso, Shimelis Techalew, Tadesse Endale, Gebreselassie Solomon. Aerobic bacterial isolates from post-surgical wound and their antimicrobial susceptibility pattern: a hospital based cross-sectional study. J Med Res. 2014;3(2):18–23.
  36.  
    1. Asres Getachew Seyoum, Legese Melese Hailu, Woldearegay Gebru Mulugeta. Prevalence of Multidrug Resistant Bacteria in Postoperative Wound Infections at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Arch Med. 2017;9(4):12.
  37.  
    1. National Nosocomial Infections Surveillance (NNIS) System National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986–April 1996, issued May 1996. Am J Infect Control. 1996;24(5):380–388. - PubMed
  38.  
    1. Esposito S, Gioia R, de Simone G, et al. Bacterial Epidemiology and Antimicrobial Resistance in the Surgery Wards of a Large Teaching Hospital in Southern Italy. Mediterr J Hematol Infect Dis. 2015;7(1):1. - PMC - PubMed
  39.  
    1. Bibi S, Channa GA, Siddiqui TR, Ahmed W. Pattern of bacterial pathogens in postoperative wounds and their sensitivity patterns in Karachi, Pakistan. J Surg Pakistan. 2012;17(4):164–167.
  40.  
    1. Camporese A, Santini G. Surveillance of antibiotic-resistant microorganisms for the rational use of antimicrobial drugs. Infez Med. 1999;7(3):172–176. - PubMed

Page Navigation