Incidence of and risk factors for surgical site infection after colorectal surgery: A multiple-center prospective study of 3,663 consecutive patients in China

Abstract

Background: Surgical site infection (SSI) after colorectal surgery (CRS) remains a significant problem for its negative clinical outcomes. However, it is poorly understood in China. This study aims to investigate the incidence, risk factors and microbiology of SSI after CRS. Methods: A nationwide prospective multicenter design was applied. Patients in 19 Chinese hospitals from 2015 to 2018 were prospectively monitored for SSI after CRS. Demographic data, hospital characteristics, and potential perioperative risk factors were collected and analyzed, using univariate and multivariate logistic regression models. Results: Among 3,663 study participants, 134(3.66%) episodes of SSI were identified. The incidence rate of SSI decreased from 5.9 infections per 100 procedures in 2015 to 3.1 infections per 100 procedures in 2018 (incidence rate ratio, 0.52; 95% CI, 0.28-0.94). The SSI rates were 1.88, 4.15, 6.27 and 11.58 per 100 operations for the National Nosocomial Infections Surveillance system (NNIS) risk index categories of 0, 1, and 2 or 3, respectively. Escherichia coli (54/134, 40.3%) and Klebsiella pneumoniae (10/134, 7.5%) were the most frequently isolated microorganisms. A high prevalence of antibiotic resistance were observed in our study, with rates of extended spectrum beta-lactamase-producing or carbapenem-resistant Escherichia coli and Klebsiella pneumonia of 50.0%(27/54) and 30.0%(3/10) respectively. Preoperative hospital stay ! 48 h (OR = 2.28, 95% CI: 1.03-5.02, P = 0.042) and contaminated or dirty wound (OR = 3.38, 95% CI: 1.88-6.06, P = 4.50 Â 10 À5 ) were significantly associated with increasing risk of SSI after CRS. Conclusion: A statistically significant but modest decrease in the incidence rate of CRS SSI over the 4-year study period was observed in this study. Noticeably, the relatively high rates of multidrug-resistant pathogens causing SSI after CRS should be alert, while more studies with large population are needed due to the small number of isolates identified in our survey.

Differences in risk factors for surgical site infection between laparotomy and laparoscopy in gastrointestinal surgery

“…Surgical site infections (SSIs) are the most frequently reported type of healthcare-associated infection, accounting for approximately 20% of all healthcare-associated infections in the United States [1] and in Europe [2] SSIs lead to reoperation, delayed discharge from hospital, reduced quality of life, and increased mortality rates [3][4][5]. The incidence of SSI in gastrointestinal surgery is significantly higher than that in surgical procedures on other organ sites [6,7], ranging from 3.7-6.4% in colorectal surgery [8][9][10][11] to 3.6-14.2% in gastric surgery [12][13][14].…”

Operating room architecture is not a risk factor for surgical site infections

“…Future studies may opt to investigate even larger sample sizes and include more variables if possible. Sixth, previous studies have shown that junior surgeons may pose an increased risk (OR = 2.4) of surgical site infections as reported by Hou et al 21 . In our study, there were a number of different surgeons in each subspecialty.…”

Incidence and risk factors of surgical site infection following colorectal surgery in Iran: a prospective cohort study

“…Overall, in this study, we identi ed 56 cases (23.33%) of SSI among 240 cases of colon cancer surgery. In different studies, the results show that the incidence of SSI ranges from 3.6% [19] and 3.3% [20] to 32.1% [20], which may be due to the fact that in some studies the de nition of SSI is different. Also, the period of time that patients are followed is different in each study [21][22][23].…”