Article

Surgical site infections in orthopedic patients: Prospective cohort study

Ljiljana Markovic-Denic, Institute of Epidemiology, School of Medicine, Visegradska 26, 11000 Belgrade, Serbia, .
Croatian Medical Journal (Impact Factor: 1.37). 02/2008; 49(1):58-65. DOI: 10.3325/cmj.2008.1.58
Source: PubMed

ABSTRACT To estimate the incidence rate and risk factors of surgical site infections in the orthopedic wards in a major teaching hospital in Serbia.
A 6-month prospective cohort study, with 30 days of patient follow-up after surgery, was conducted at the teaching hospital in Belgrade. We collected patients' basic demographic data and data on underlying disease status, surgical procedures, preoperative preparation of patients, and antibiotic prophylaxis. The National Nosocomial Infections Surveillance (NNIS) risk index was computed for each patient. Descriptive and logistic regression analyses were performed to determine risk factors for surgical site infections.
Assessment of 277 patients after operation revealed surgical site infection in 63 patients. In 3 (4.8%) of them, surgical site infections were detected after hospital discharge. The overall incidence rate of surgical site infections was 22.7% (95% confidence interval [95% CI], 17.5-29.1). The incidence increased from 13.2% in clean wounds to 70.0% in dirty wounds. The rates of surgical site infection for the NNIS risk index classes 0 to 3 were 8.1% (13 of 161), 36.4% (32 of 88), 63.0% (17 of 27), and 100% (1 of 1) (P<0.001; chi2 test). Multivariate logistic regression analysis identified the following independent risk factors for surgical site infections: greater number of persons in the operating room (odds ratio [OR], 1.28; 95% CI, 1.02-1.60), contaminated or dirty wounds (OR, 12.09; 95% CI, 5.56-26.28), and American Society of Anesthesiologists' (ASA) score >2 (OR, 3.47; 95% CI, 1.51-7.95). In patients who were shaved with a razor, the period of 12 or more hours between shaving and intervention was also an independent risk factor (OR, 2.77; 95% CI, 1.22-6.28).
There is a high incidence of surgical site infections in orthopedic patients in Serbia in comparison with developed countries and some developing countries. Points for intervention could be reduction of personnel during surgery, better treatment of wounds, decreasing ASA score, and reduction of the time between surgical site shaving and the intervention.

1 Follower
 · 
314 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Surgical site infection (SSI) is the most common complication following surgical procedures. The aim of this study was to determine the incidence and associated risk factors of SSI in orthopedic patients admitted in a tertiary care center. Data were collected which focused on demographic details, lifestyle factors, diagnosis, surgical procedure, duration of surgery, prophylactic antibiotics, postoperative antibiotics and comorbidity obtained from the patients hospital records. Univariate analysis and multinomial logistic regression tests were performed to identify independent risk factors for orthopedic incisional SSIs. The overall rate of SSI was 2.1 %. Univariate analysis showed diabetes, smoking and duration of hospital stay to be significantly associated with patients in whom SSI developed than in uninfected control patients. Independent risk factors for SSI that were identified by multinomial logistic regression were diabetes (OR 3.953) and smoking (OR 38.319). Diabetes and smoking were independent risk factors for SSIs. Therefore, it is recommended to tightly regulate blood glucose levels and stop smoking to reduce the SSIs.
    European Journal of Orthopaedic Surgery & Traumatology 05/2014; DOI:10.1007/s00590-014-1475-3 · 0.18 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Surgical site infections (SSIs) still cause significant morbidity and mortality despite advances in trauma care. We have studied in this paper the rate of SSIs, their outcomes in patients undergoing interventions for trauma and SSI trends in developing countries. Materials and Methods: A 16-month study (May, 2011- August, 2012) was carried out. Patients undergoing interventions for orthopedic trauma were followed and assessed for SSIs and their outcomes and antimicrobial sensitivity patterns of the micro-organisms isolated were noted and correlated. Results: A total of 40 (4.4%) confirmed cases of SSIs were identified among 852 patients of orthopedic trauma. Based on the new CDC criteria, after ruling out cellulitis, only 24 (2.6%) were found to have SSIs. A total of 12.5% of the SSIs were detected during follow-up. Acinetobacter baumannii was the predominant organism as also Staphylococcus aureus. Outcomes observed included changes in antibiotic regime, revision surgery, readmission to hospital and deaths. Conclusion: SSI is prevalent in orthopaedic trauma patients and an active surveillance program will help in early management and prevention.
    Journal of Postgraduate Medicine 07/2014; 60(3):254-259. DOI:10.4103/0022-3859.138731 · 0.97 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Surgical site infection (SSI) is disastrous in orthopedic practice as it is difficult to rid the bone and joint of the infection. This study was aimed to assess the prevalence of SSI in orthopedic practice and to identify risk factors associated with surgical site infections. All patients admitted to the orthopedic male and female wards between January 2006 and December 2011 were included in the study group. The data, which were collected from the medical charts and from the QuadraMed patient filing system, included age, sex, date of admission, type of admission (elective versus emergency), and classification of fractures. Analyses were made to find out the association between infection and risk factors, the χ (2) test was used. The strength of association of the single event with the variables was estimated using Relative Risk, with a 95% confidence interval and P < 0.05. A total of 79 of 3096 patients (2.55%) were included: 60 males and 19 females with the average age of 38.13 ± 19.1 years. Fifty-three patients were admitted directly to the orthopedic wards, 14 were transferred from the surgical intensive care unit, and 12 from other surgical wards. The most common infective organism was Staphylococcus species including Methicillin Resistant Staphylococcus aureus (MRSA), 23 patients (29.11%); Acinetobacter species, 17 patients (21.5%); Pseudomonas species, 15 patients (18.9%); and Enterococcus species, 14 patients (17.7%). Fifty-two (65.8%) had emergency procedures, and in 57 patients trauma surgery was performed. Three (3.78%) patients died as a result of uncontrolled septicemia. SSI was found to be common in our practice. Emergency surgical procedures carried the greatest risk with Staphylococcus species and Acinetobacter species being the most common infecting organisms. Proper measures need to be undertaken to control infection rates by every available method; antibiotics alone may not be sufficient to win this war.
    International surgery 99(3):264-8. DOI:10.9738/INTSURG-D-13-00251.1 · 0.25 Impact Factor

Full-text (2 Sources)

Download
36 Downloads
Available from
May 21, 2014