When cefuroxime is used as a prophylactic antibiotic, administration 59 to 30 minutes before incision is more effective than administration during the last half hour.

OBJECTIVE. To quantify the economic burden of in-hospital surgical site infections (SSIs) at a European university hospital.DESIGN. Matched case-control study nested in a prospective observational cohort study.SETTING. Basel University Hospital in Switzerland, where an average of 28,000 surgical procedures are performed per year.METHODS. All in-hospital occurrences of SSI associated with surgeries performed between January 1, 2000, and December 31, 2001, by the visceral, vascular, and traumatology divisions at Basel University Hospital were prospectively recorded. Each case patient was matched to a control patient by age, procedure code, and National Nosocomial Infection Surveillance System risk index. The case-control pairs were analyzed for differences in cost of hospital care and in provision of specialized care.RESULTS. A total of 6,283 procedures were performed: 187 SSIs were detected in inpatients, 168 of whom were successfully matched with a control patient. For case patients, the mean additional hospital cost was SwF19,638 (95% confidence interval [CI], SwF8,492-SwF30,784); the mean additional postoperative length of hospital stay was 16.8 days (95% CI, 13-20.6 days); and the mean additional in-hospital duration of antibiotic therapy was 7.4 days (95% CI, 5.1-9.6 days). Differences were primarily attributable to organ space SSIs (« = 76).CONCLUSIONS. Ina European university hospital setting, SSIs are costly and constitute a heavy and potentially preventable burden on both patients and healthcare providers. 2008; 29:623-629 Surgical site infections (SSIs) account for 14%-16% of all nosocomial infections in inpatients and are considered the most common form of nosocomial infection among surgical patients. 1 A number of risk factors have been associated with the onset of SSI, and they can be broadly subdivided into patientrelated characteristics (eg, greater age, poor nutritional status, and more numerous and/or more severe combrbid conditions) and surgery-related characteristics (eg, long duration of procedure, high wound classification, and absence of antibiotic prophylaxis). 26 Based on such risk factors, SSI prediction scores have been developed that allow the identification of patients at high risk for developing SSI. 5,7,8 For these high-risk patients, clinicians can implement appropriate prevention strategies and effective measures to diagnose infection and initiate therapy at an early stage. In addition, in the past few years, SSI surveillance systems have been shown to decrease the rates of SSI in various countries. 1 ' 916 In such systems, clinicians share feedback on infection rates with surgical staff and reinforce adherence to Centers for Disease Control and Prevention standards. A nosocomial infection surveillance system was introduced at Basel University Hospital in 1999 to decrease the rate of SSI. Infect Control Hosp EpidemiolNowadays, hospital infections, particularly SSIs-which are potentially preventable complications directly linked to surgery-are considered to reflect the quality of...

Our findings point to important confounding factors and strengthen existing doubts on leukoreduced ABT during general surgery and preoperative anemia as risk factors for SSIs.