Prevention and treatment of surgical site infection in HIV-infected patients

Zhang, Lei; Liu, Baochi; Zhang, Xiaoyan; Li, Lei; Xia, Xianjun; Guo, Ruizhang

doi:10.1186/1471-2334-12-115

Cited by 41 publications

(36 citation statements)

References 20 publications

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“…[24,25] However, in the current study the 14 cases of wound infection all occurred in HIV-noninfected patients. The absence of excess wound infection rates in HIV-infected patients has also been reported in comparative studies in orthopaedic [26], cardiovascular [27] and various other types of surgery.…”

Section: Discussionmentioning

confidence: 77%

The effect of HIV infection on the surgical, chemo- and radiotherapy management of breast cancer. A prospective cohort study

Phakathi

Basson

Karusseit

et al. 2016

International Journal of Surgery

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Section: Discussionmentioning

confidence: 77%

The effect of HIV infection on the surgical, chemo- and radiotherapy management of breast cancer. A prospective cohort study

Phakathi

Basson

Karusseit

et al. 2016

International Journal of Surgery

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“…Those few studies that examined death often were underpowered to perform multivariate analyses. Some reports continued to show increased complications 22,23,44–50 and death 44,46,49 in patients with HIV infection, but others documented declining rates of surgical complications and deaths in the HIV infection group that rivaled those experienced by uninfected individuals across many surgical specialties including orthopedics, 51–57 cardiovascular surgery, 13,58–61 bariatric surgery, 62 transplant surgery, 16,24,63 obstetrics, 10,11,64 urologic surgery, 65 neurosurgery, 66 and general surgery. 12,14,15 …”

Section: Discussionmentioning

confidence: 99%

Thirty-Day Postoperative Mortality Among Individuals With HIV Infection Receiving Antiretroviral Therapy and Procedure-Matched, Uninfected Comparators

et al. 2015

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IMPORTANCE Antiretroviral therapy (ART) has converted human immunodeficiency virus (HIV) infection into a chronic condition, and patients now undergo a variety of surgical procedures, but current surgical outcomes are inadequately characterized. OBJECTIVE To compare 30-day postoperative mortality in patients with HIV infection receiving ART with the rates in uninfected individuals. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of nationwide electronic medical record data from the US Veterans Health Administration Healthcare System, October 1, 1996, to September 30, 2010. Common inpatient surgical procedures were grouped using the Healthcare Cost and Utilization Project Clinical Classification System to match HIV-infected and uninfected patients in a 1:2 ratio. Data on 1641 patients with HIV infection receiving combination ART who were undergoing inpatient surgery were compared with data on 3282 procedure-matched, uninfected comparators. Poisson regression models of 30-day postoperative mortality were adjusted for procedure year, age, Charlson Comorbidity Index score, hemoglobin level, albumin level, HIV infection, CD4 cell count, and HIV-1 RNA level. MAIN OUTCOMES AND MEASURES All-cause 30-day postoperative mortality. RESULTS The most common procedures in both groups were cholecystectomy (10.5%), hip arthroplasty (10.5%), spine surgery (9.8%), herniorrhaphy (7.4%), and coronary artery bypass grafting (7.0%). In patients with HIV infection, CD4 cell distributions were 80.0% with 200/µL or more, 16.3% with 50/µL to 199/µL, and 3.7% with less than 50/µL; 74.1% of patients with HIV infection had undetectable HIV-1 RNA. Human immunodeficiency virus infection was associated with higher 30-day postoperative mortality compared with the mortality in uninfected patients (3.4% [56 patients]) vs 1.6% [53]); incidence rate ratio [IRR], 2.11; 95% CI, 1.41–3.17; P < .001). CD4 cell count was inversely associated with mortality, but HIV-1 RNA provided no additional information. After adjustment, patients with HIV infection had increased mortality compared with uninfected patients at all CD4 cell count strata (≥500/µL: IRR, 1.92; 95% CI, 1.02–3.60; P = .04; 200–499/µL: IRR, 1.89; 95% CI, 1.20–2.98; P = .01; 50–199/µL: IRR, 2.66; 95% CI, 1.29–5.47; P = .01; and <50/µL: IRR, 6.21; 95% CI, 3.55–10.85; P < .001). Hypoalbuminemia (IRR, 4.35; 95% CI, 2.78–6.81; P < .001) and age in decades (IRR, 1.47; 95% CI, 1.23–1.76; P < .001) were also strongly associated with mortality. CONCLUSIONS AND RELEVANCE Current postoperative mortality rates among individuals with HIV infection who are receiving ART are low and are influenced as much by hypoalbuminemia and age as by CD4 cell status. Human immunodeficiency virus infection and CD4 cell count are only 2 of many factors associated with surgical outcomes that should be incorporated into surgical decision making.

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“…Diabetes and HIV have severally been documented as a risk factor for surgical site infections [25,26]. The reason for this includes depression of the patient's immunity, thus bacteria colonization of surgical site easily transforms into established infection.…”

Section: Premorbid Status and Ssimentioning

confidence: 99%

Role of premorbid status and wound related factors in surgical site infection in a tertiary hospital in sub-saharan Africa

Osakwe¹,

Nnaji²,

Osakwe³

et al. 2014

Fam Pract Rep

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Background: Surgical site infection (SSI) is the commonest hospital acquired infection in surgical patients globally. It has remained a major cause of morbidity and mortality and a major source of worry to both the patients, doctors, hospitals and the community as a whole. Aim: To determine the role of premorbid status, wound class and cadre of surgeons on the prevalence rate of surgical site infections. Materials and methods: This was a cross-sectional study involving 200 randomly recruited surgical patients between April and June 2012 at Nnamdi Azikiwe University Teaching Hospital, Nnewi. Pre-tested, interviewer administered questionnaires and laboratory test results were used to collect data, which were analyzed using Statistical Package for Social Sciences, version 16. Results: The prevalence of surgical site infection was 15.5% (or 31 of 200) among the participants. Premorbid status, as well as, wound class, of the patients affected the rate of SSI (p=0.007) and (p=0.009), respectively. However, the wound location did not show any significant effect on the prevalence of SSI. Conclusion:The study found a high prevalence of SSI which was dependent on the class of wound, and premorbid status of the patient.

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Prevention and treatment of surgical site infection in HIV-infected patients

Cited by 41 publications

References 20 publications

The effect of HIV infection on the surgical, chemo- and radiotherapy management of breast cancer. A prospective cohort study

The effect of HIV infection on the surgical, chemo- and radiotherapy management of breast cancer. A prospective cohort study

Thirty-Day Postoperative Mortality Among Individuals With HIV Infection Receiving Antiretroviral Therapy and Procedure-Matched, Uninfected Comparators

Role of premorbid status and wound related factors in surgical site infection in a tertiary hospital in sub-saharan Africa

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