Gender-Specific Differences in Surgical Site Infections: An Analysis of 438,050 Surgical Procedures from the German National Nosocomial Infections Surveillance System

Abstract

Background: Surgical site infections (SSI) are among the most frequent healthcare-associated infections. They impose a substantial burden with increased morbidity and exceeding healthcare costs. Risk factors such as age, diabetes, and smoking status are commonly accounted for in the literature, but few studies address gender differences. Methods: Data from the German Nosocomial Infections Surveillance System (Krankenhaus-Infektions-Surveillance-System (KISS)) from 2005 to 2010 were analysed for cardiac, vascular, visceral, and orthopaedic surgery, with a total of 438,050 surgical procedures and 8,639 SSI. Rates of SSI and isolated pathogens were analysed for gender. Results: Women had a lower rate of SSI (SSI/100 procedures) in abdominal surgery than men (2.92 vs. 4.37; p < 0.001). No gender-specific differences were found in orthopaedic and vascular surgery, while women had a higher risk for SSI in cardiac surgery (5.50 vs. 3.02; p < 0.001). Isolated pathogens showed differences for sensitive Staphylococcus aureus and Pseudomonas aeruginosa, which were more frequent in women (both p = 0.007), while coagulase-negative staphylococci occurred more often in men (18.8 vs. 14.0%; p < 0.001). Conclusion: Gender differences in SSI exist and are procedure-specific. The underlying mechanisms need to be further elucidated so that targeted measures for the prevention of SSI can be developed.

Burden of Staphylococcus aureus infections after orthopedic surgery in Germany

“…This study assessed the burden of post-surgical SAI among orthopedic surgery patients in Germany. We identified a similar near term SAI infection risk as a prior study in Germany [5]. In our analysis 0.77% of patients were infected by S. aureus within 90 days of index endoprosthetic surgery (0.46% for knee surgeries; 1.01% Fig.…”

“…S. aureus, Staphylococcus aureus for hip surgeries; 0.66% spine surgeries). In previous German studies, 0.98% of patients who underwent orthopedic surgeries acquired SSI, with approximately one-third of SSI caused by S. aureus [5,9]. As late SSIs (e.g.…”

“…Postoperative surgical site infections (SSIs) are associated with increased morbidity and mortality, decreased quality of life for patients [1][2][3][4], and higher hospitalization costs compared with surgery patients without such infections [4][5][6]. Previous studies have found 20% of SSIs are Staphylococcus aureus (S. aureus), making it the most common SSI pathogen identified [7][8][9].…”

“…In Germany nearly 251 hip replacements and 180 total knee replacement surgeries per 100,000 inhabitants occur annually, representing one of the highest frequencies among EU Member States [13,14]. One German study found an SSI rate of 0.98% following orthopedic surgeries with S. aureus causing approximately one-third [5]. Previous studies of S. aureus infections (SAI) in Germany were conducted in single centers, had relatively short followup periods [15,16], reported SSI rates regardless of pathogen [1,17], or focused on specific subgroups [18,19].…”

Bacteriological study of surgical site infections in a tertiary care hospital at Miraj, Maharashtra state, India

“…2 There is substantial burden with increased morbidity and exceeding healthcare costs. 3 Despite efforts to control infection and better understanding of sepsis, wound infection is still a clinical problem and some infections in clean wounds still remain unexplained. 4 In many SSIs, the responsible pathogens originate from patient's endogenous flora.…”