Risk of Surgical Site Infection in Older Patients in a Cohort Survey: Targets for Quality Improvement in Antibiotic Prophylaxis

Abstract

The aims of the present study were to: (1) assess surgical site infection (SSI) incidence in a cohort of surgical patients and (2) estimate the compliance with national guidelines for perioperative antibiotic prophylaxis (PAP). SSIs, among the most common health care-associated infections, are an important target for surveillance and an official priority in several European countries. SSI commonly complicates surgical procedures in older people and is associated with substantial attributable mortality and costs. The implementation of PAP guidelines is difficult among surgeons, and failure to comply with the standard of care has been widely reported. A 12-month prospective survey was performed in accordance with the methods, protocols, and definitions of the Hospital in Europe Link for Infection Control through Surveillance (HELICS) protocol. The compliance of the current PAP practices with the published national guidelines was assessed. A total of 249 patients were enrolled. The cumulative SSI incidence was 3.2 per 100 operative procedures. Cumulative compliance for PAP was 12.4%. Overall, only infection risk index ≥ 1 was confirmed as a significant risk factor for SSI (odds ratio, 6.65; 95% confidence interval, 1.04-42.59; P = 0.045). When only older patients (age >65 years) were considered, no significant risk factors for SSI were identified. Our study indicates an overall inadequate compliance with PAP recommendations, thus highlighting the need to develop multimodal and targeted intervention programs to improve compliance with PAP guidelines.

Three-Year Trends of Healthcare-Associated Infections and Antibiotic Use in Acute Care Hospitals: Findings from 2016–2018 Point Prevalence Surveys in Sicily, Italy

“…By contrast, our analysis demonstrated that prevalence of HAIs remained stable from 2016 to 2018, with a negative but not significant peak in 2017. This was partly comforting since patients participating in the Sicilian PPSs became older and more severe over the years, although it is well known that aging and disease severity are risk factors for HAIs [ 26 , 27 , 28 ]. In line, we noted an increasing trend in the presence of invasive devices from 2016 to 2018, but it also did not result in an increased prevalence of HAIs.…”

Determinants of surgeons’ adherence to preventive intraoperative measures of surgical site infection in Gaza Strip hospitals: a multi-centre cross-sectional study

“…The WHO guidelines [8] aim to achieve this, but several studies have shown that adherence is not optimal [33][34][35]. In comparison to a Brazilian study [15], this study found a higher rate of administering surgical antibiotic prophylaxis (96.0% vs 77.6%), which was comparable to an Italian study [16] (96.0% vs 96.8%). The effectivity of surgical antibiotic prophylaxis may depend on the type of surgery performed [36], and as a result, if a surgeon is aware of this, the adherence to SSI prevention guidelines might be expected to be improved.…”

“…However, even if age group does not have a direct association, it can interplay with other factors related to the procedure. Older patients tend to have more frequent emergency surgeries than younger ones and longer operating times [16]. This study shows that both of these factors increase the likelihood of poor adherence to SSI prevention guidelines, with surgeons demonstrating poorer adherence in emergency surgeries and with longer operating times.…”

“…Descriptive statistics including frequencies and percentages for demographic data and the performed preventive measures were calculated. Age was categorized into three groups based on the relative risk of each one with the incidence of SSI described by previous studies [16,17]. The same concept was applied to categorizing the duration of surgical procedures [18,19].…”

Agentes relacionados a infección de sitio operatorio en adultos mayores pos operados en el Centro Médico Naval, 2013 – 2017

“…Esta población se caracteriza por tener un patrón de comorbilidades, las cuales desde el punto de vista quirúrgico son determinantes para el surgimiento de algunas complicaciones durante su estancia hospitalaria completa. Identificar estas comorbilidades y condiciones asociadas permitirán disminuir tanto las complicaciones intrahoperatorias como las postoperatorias para lograr no solo un buen acto quirúrgico, sino uno exitoso 5,6 .…”