SummaryBackgroundSurgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world.MethodsThis international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231.FindingsBetween Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001).InterpretationCountries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication.FundingDFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant,...

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A dosimetric survey has been carried out in order to investigate typical radiation doses for children undergoing a number of common x-ray examinations in Nigeria. The results presented in this work are derived from the data of 226 children from three different hospitals included in the survey. Assuming the sample is representative of national practice patterns, pediatric chest examinations are the most frequent radiological examinations. Doses were measured by attaching thermoluminescent dosimeters to the patient's skin to determine entrance surface dose (ESD). The mean and standard deviation of the individual ESD values are reported. Comparisons were made between these doses and diagnostic reference levels, and also between the doses and those from other countries. The mean ESD values in the present work are found to be generally higher than those found in an UNSCEAR document and the NRPB diagnostic reference levels. The ratio of maximum ESD to minimum ESD, a parameter that characterizes ESD variation, was found to be less than 10 in each of the hospitals, while across the three hospitals the ratio was found to be greater than 10. The reasons for the high mean ESD and the variations in patients' ESD values have been discussed in terms of regulatory control, personnel, difference in radiological techniques, performance of x-ray facility, film processing condition, and the type of film-screen combination used. The results presented in this work will form part of the baseline data needed for deriving national guidance levels of pediatric radiological examination. In addition, it will also serve as a source of additional information on pediatric patient dosimetry. Suggestions are given on how to reduce doses to pediatric patients during x-ray examinations, especially in developing countries.

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