CDC definitions of nosocomial surgical site infections, 1992: A modification of CDC definitions of surgical wound infections

Horan, Teresa C.; Gaynes, Robert P.; Martone, William J.; Jarvis, William R.; Emori, T. Grace

doi:10.1016/s0196-6553(05)80201-9

Cited by 1,821 publications

(825 citation statements)

References 5 publications

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“…Antibiotic-impregnated cement was not routinely used for primary THA/ TKA during the study period. The rate of SSI in this series of patients was shown to be similar between the two groups and previously published [17,36]. The study was approved and conducted according to the guidelines set forth by our institutional review board.…”

Section: Methodssupporting

confidence: 80%

Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty

Courtney

Melnic

Zimmer

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background With increasing prevalence of methicillinresistant Staphylococcus aureus (MRSA) in patients undergoing hip and knee arthroplasty, some have advocated a dual-antibiotic regimen including vancomycin as prophylaxis against surgical site infections. However, routine administration of vancomycin may result in impaired renal functions in susceptible patients. Questions/purposes The purpose of this study was to determine whether patients receiving antibiotic prophylaxis with cefazolin and vancomycin have a higher risk of postoperative acute kidney injury (AKI) compared with patients receiving cefazolin alone before elective primary hip and knee arthroplasty. We also aimed to compare severity and recovery of AKI in these two cohorts and to determine independent risk factors for AKI. Methods We retrospectively evaluated a series of 1828 patients undergoing primary hip and knee arthroplasty over a 2-year period who received either cefazolin (n = 500) or cefazolin and vancomycin (n = 1328) as perioperative antibiotic prophylaxis. During the study period, a perceived high prevalence of MRSA infections at our institution led some surgeons to add vancomycin to the prophylactic antibiotic regimen. The patient characteristics, case mix, and preoperative renal function and baseline creatinine clearance were similar between the two groups. We defined AKI according to the published Acute Kidney Injury Network (AKIN) criteria, and the risk of AKI in both groups was compared. We also compared the proportions of patients by AKIN severity stage and assessed recovery as defined by creatinine levels showing kidney function reaching 50% baseline. The American Society of Anesthesiologists (ASA) classification, preoperative chronic kidney disease, intraoperative fluid requirements, and estimated blood loss were recorded. We analyzed the data using a multivariate logistic regression model to identify potential independent risk factors, including dual antibiotic therapy. Results Patients receiving dual antibiotics were more likely to develop AKI compared with those receiving cefazolin alone (13% versus 8%, p = 0.002). Dual-antibiotic prophylaxis also was associated with greater severity; patients in the dual antibiotic group had higher rates of Grade II and III acute kidney injury (3% versus 0%, p = 0.003). There was no difference in the rate of return to baseline renal function (2 ± 1.4 days versus 3 ± 3.4 days; mean difference, 0.5 days; 95% confidence interval [CI], À0.2 to 1.2 days; p = 0.155). Controlling for confounding variables, dual antibiotic prophylaxis (adjusted odds ratio [OR], 1.82; 95% CI, 1.25-2.64; p = 0.002), ASA class

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Section: Methodssupporting

confidence: 80%

Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty

Courtney

Melnic

Zimmer

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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“…At the 6-month postoperative review, information from the medical file regarding length of hospital stay, adverse events, and discharge destination was extracted. Adverse events were classified according to the system used in a previously published study [13] and included (1) death relating to the procedure; (2) perioperative complications; (3) postoperative complications resulting in discharge delay; and/or (4) suture line problems, eg, hematoma, dehiscence, wound necrosis, or wound or joint infection as per the definition of Surgical Site Infection from the Centers for Disease Control and Prevention [22].…”

Section: Methodsmentioning

confidence: 99%

Do Activity Levels Increase After Total Hip and Knee Arthroplasty?

Harding

Holland

Delany

et al. 2014

Clinical Orthopaedics &Amp; Related Research

183

189

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“…The definition of SSI of Horgan et al [4] was applied in this review. Wound dehiscence was defined as a wound showing breakdown in the absence of clinical signs meeting the diagnostic standard for SSI.…”

Section: Methodsmentioning

confidence: 99%

Experience with wound complications after surgery for sacral tumors

Guo

et al. 2013

Eur Spine J

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Purpose The aim of this article is to summarize our experience in treating sacral wound complications after sacrectomy. We focus, in particular, on factors associated with wound complications, including surgical site infection (SSI) and wound dehiscence. Methods The definition of SSI devised by Horgan et al. was applied. Wound dehiscence was defined as a wound showing breakdown in the absence of clinical signs meeting the diagnostic standard for SSI. Between September 1997 and August 2009, 387 patients with a sacral tumor underwent sacrectomy performed by the same team of surgeons and were followed up for C12 months. Potential risk factors were evaluated for univariate associations with SSI and wound complications. Multivariable conditional logistic regression was used to identify the combined effects of several risk factors. Results Of the 387 wounds studied, 274 healed uneventfully, and 113 (29.2 %) broke down because of infection or dehiscence. Fifty-one (13.2 %) patients developed a postoperative SSI, and 62 (16.0 %) patients developed wound dehiscence. Gram-negative bacteria grew in 45 cultures (91.8 %) and included 38 cases of Escherichia coli. Previous radiation, rectum rupture, longer duration of surgery, and cerebrospinal fluid leakage were significantly associated with increased likelihood of developing an SSI. Previous radiation, rectum rupture, age \40 years, history of diabetes mellitus, maximum tumor diameter C10 cm, and instrumentation used were risk factors for wound complications. Conclusions The incidence of wound complications is not so high at a musculoskeletal tumor center with surgeons experienced in treating sacral tumors. Controlling for these risk factors when possible may improve clinical outcomes.

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CDC definitions of nosocomial surgical site infections, 1992: A modification of CDC definitions of surgical wound infections

Cited by 1,821 publications

References 5 publications

Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty

Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty

Do Activity Levels Increase After Total Hip and Knee Arthroplasty?

Experience with wound complications after surgery for sacral tumors

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