Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: A prospective, international, multicentre cohort study

Background: Surgical 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. Methods: This 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. Findings: Between 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). Interpretation: Countries 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. Funding: DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant.

Data di pubblicazione: 2018
Titolo: Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: A prospective, international, multicentre cohort study
Autori: Bhangu, Aneel; Ademuyiwa, Adesoji O; Aguilera, Maria Lorena; Alexander, Philip; Al-Saqqa, Sara W; Borda-Luque, Giuliano; Costas-Chavarri, Ainhoa; Drake, Thomas M; Ntirenganya, Faustin; Fitzgerald, J Edward; Fergusson, Stuart J; Glasbey, James; Ingabire, JC Allen; Ismaïl, Lawani; Salem, Hosni Khairy; Kojo, Anyomih Theophilus Teddy; Lapitan, Marie Carmela; Lilford, Richard; Mihaljevic, Andre L; Morton, Dion; Mutabazi, Alphonse Zeta; Nepogodiev, Dmitri; Adisa, Adewale O; Ots, Riinu; Pata, Francesco; Pinkney, Thomas; Poškus, Tomas; Qureshi, Ahmad Uzair; Ramos-De la Medina, Antonio; Rayne, Sarah; Shaw, Catherine A; Shu, Sebastian; Spence, Richard; Smart, Neil; Tabiri, Stephen; Harrison, Ewen M; Khatri, Chetan; Mohan, Midhun; Jaffry, Zahra; Altamini, Afnan; Kirby, Andrew; Søreide, Kjetil; Recinos, Gustavo; Cornick, Jen; Modolo, Maria Marta; Iyer, Dushyant; King, Sebastian; Arthur, Tom; Nahar, Sayeda Nazmum; Waterman, Ade; Walsh, Michael; Agarwal, Arnav; Zani, Augusto; Firdouse, Mohammed; Rouse, Tyler; Liu, Qinyang; Correa, Juan Camilo; Talving, Peep; Worku, Mengistu; Arnaud, Alexis; Kalles, Vassilis; Kumar, Basant; Kumar, Sunil; Amandito, Radhian; Quek, Roy; Ansaloni, Luca; Altibi, Ahmed; Venskutonis, Donatas; Zilinskas, Justas; Poskus, Tomas; Whitaker, John; Msosa, Vanessa; Tew, Yong Yong; Farrugia, Alexia; Borg, Elaine; Bentounsi, Zineb; Gala, Tanzeela; Al-Slaibi, Ibrahim; Tahboub, Haya; Alser, Osaid H; Romani, Diego; Shu, Sebestian; Major, Piotr; Mironescu, Aurel; Bratu, Matei; Kourdouli, Amar; Ndajiwo, Aliyu; Altwijri, Abdulaziz; Alsaggaf, Mohammed Ubaid; Gudal, Ahmad; Jubran, Al Faifi; Seisay, Sam; Lieske, Bettina; Ortega, Irene; Jeyakumar, Jenifa; Senanayake, Kithsiri J; Abdulbagi, Omar; Cengiz, Yucel; Raptis, Dmitri; Altinel, Yuksel; Kong, Chia; Teasdale, Ella; Irwin, Gareth; Stoddart, Michael; Kabariti, Rakan; Suresh, Sukrit; Gash, Katherine; Narayanan, Ragavan; Maimbo, Mayaba; Grizhja, Besmir; Ymeri, Shpetim; Galiqi, Gezim; Klappenbach, Roberto; Antezana, Diego; Mendoza Beleño, Alvaro Enrique; Costa, Cecilia; Sanchez, Belen; Aviles, Susan; Fermani, Claudio Gabriel; Balmaceda, Rubén; Villalobos, Santiago; Carmona, Juan Manuel; Hamill, Daniel; Deutschmann, Peter; Sandler, Simone; Cox, Daniel; Nataraja, Ram; Sharpin, Claire; Ljuhar, Damir; Gray, Demi; Haines, Morgan; Iyer, Dush; Niranjan, Nithya; D'Amours, Scott; Ashtari, Morvarid; Franco, Helena; Rahman Mitul, Ashrarur; Karim, Sabbir; Aman, Nowrin F; Estee, Mahnuma Mahfuz; Salma, Umme; Razzaque, Joyeta; Hamid Kanta, Tasnia; Tori, Sayeeda Aktar; Alamin, Shadid; Roy, Swapnil; Al Amin, Shadid; Karim, Rezaul; Haque, Muhtarima; Faruq, Amreen; Iftekhar, Farhana; O'Shea, Margaret; Padmore, Greg; Jonnalagadda, Ramesh; Litvin, Andrey; Filatau, Aliaksandr; Paulouski, Dzmitry; Shubianok, Maryna; Shachykava, Tatsiana; Khokha, Dzianis; Khokha, Vladimir; Djivoh, Fernande; Dossou, Francis; Seto, Djifid Morel; Gbessi, Dansou Gaspard; Noukpozounkou, Bruno; Imorou Souaibou, Yacoubou; Keke, Kpèmahouton René; Hodonou, Fred; Ahounou, Ernest Yemalin Stephane; Alihonou, Thierry; Dénakpo, Max; Ahlonsou, Germain; Ginbo Bedada, Alemayehu; Nsengiyumva, Carlos; Kwizera, Sandrine; Barendegere, Venerand; Choi, Philip; Stock, Simon; Jamal, Luai; Azzie, Georges; Kushwaha, Sameer; Chen, Tzu-Ling; Yip, Chingwan; Montes, Irene; Zapata, Felipe; Sierra, Sebastian; Villegas Lanau, Maria Isabel; Mendoza Arango, Maria Clara; Mendoza Restrepo, Ivan; Restrepo Giraldo, Ruben Santiago; Domini, Edgar; Karlo, Robert; Mihanovic, Jakov; Youssef, Mohamed; Elfeki, Hossam; Thabet, Waleed; Sanad, Aly; Tawfik, Gehad; Zaki, Ahmed; Abdel-Hameed, Noran; Mostafa, Mohamed; Omar, Muhammad Fathi Waleed; Ghanem, Ahmed; Abdallah, Emad; Denewer, Adel; Emara, Eman; Rashad, Eman; Sakr, Ahmad; Elashry, Rehab; Emile, Sameh; Khafagy, Toqa; Elhamouly, Sara; Elfarargy, Arwa; Mamdouh Mohamed, Amna; Saied Nagy, Ghada; Esam, Abeer; Elwy, Eman; Hammad, Aya; Khallaf, Salwa; Ibrahim, Eman; Said Badr, Ahmed; Moustafa, Ahmed; Eldosouky Mohammed, Amany; Elgheriany, Mohammed; Abdelmageed, Eman; Al Raouf, Eman Abd; Samir Elbanby, Esraa; Elmasry, Maha; Morsy Farahat, Mahitab; Yahya Mansor, Eman; Magdy Hegazy, Eman; Gamal, Esraa; Gamal, Heba; Kandil, Hend; Maher Abdelrouf, Doaa; Moaty, Mohamed; Gamal, Dina; El-Sagheer, Nada; Salah, Mohamed; Magdy, Salma; Salah, Asmaa; Essam, Ahmed; Ali, Ahmed; Badawy, Mahmoud; Ahmed, Sara; Mohamed, Mazed; Assal, Abdelrahman; Sleem, Mohamed; Ebidy, Mai; Abd-Elrazek, Aly; Zahran, Diaaaldin; Adam, Nourhan; Nazir, Mohamed; Hassanein, Adel B; Ismail, Ahmed; Elsawy, Amira; Mamdouh, Rana; Mabrouk, Mohamed; Ahmed, Lopna Ahmed Mohamed; Hassab Alnaby, Mohamed; Magdy, Eman; Abd-Elmawla, Manar; Fahim, Marwan; Mowafy, Bassant; Ibrahim Mahmoud, Moustafa; Allam, Meran; Alkelani, Muhammad; Halim El Gendy, Noran; Saad Aboul-Naga, Mariam; Alaa El-Din, Reham; Elgendy, Alyaa Halim; Ismail, Mohamed; Shalaby, Mahmoud; Adel Elsharkawy, Aya; Elsayed Moghazy, Mahmoud; Hesham Elbisomy, Khaled; Abdel Gawad Shakshouk, Hend; Hamed, Mohamed Fouad; Ebidy, Mai Mohamed; Abdelkader, Mostafa; Karkeet, Mohamed; Ahmed, Hayam; Adel, Israa; Omar, Mohammad Elsayed; Ibrahim, Mohamed; Ghoneim, Omar; Hesham, Omar; Gamal, Shimaa; Hilal, Karim; Arafa, Omar; Adel Awad, Sawsan; Salem, Menatalla; Abdellatif Elsherif, Fawzia; Elsabbagh, Nourhan; Aboelsoud, Moustafa R; Hossam Eldin Fouad Rida, Ahmed; Hossameldin, Amr; Hany, Ethar; Hosny Asar, Yomna; Anwar, Nourhan; Gadelkarim, Mohamed; Abdelhady, Samar; Mohamed Morshedy, Eman; Saad, Reham; Soliman, Nourhan; Salama, Mahmoud; Ezzat, Eslam; Mohamed, Arwa; Ibrahim, Arwa; Fergany, Alaa; Mohammed, Sara; Reda, Aya; Allam, Yomna; Saad, Hanan Adel; Abdelfatah, Afnan; Fathy, Aya Mohamed; El-Sehily, Ahmed; Abdalmageed Kasem, Esraa; Hassan, Ahmed Tarek Abdelbaset; Mohammed, Ahmed Rabeih; Saad, Abdalla Gamal; Elfouly, Yasmin; Elfouly, Nesma; Ibrahim, Arij; Hassaan, Amr; Mohammed, Mohammed Mustafa; Elhoseny, Ghada; Magdy, Mohamed; Abd Elkhalek, Esraa; Zakaria, Yehia; Ezzat, Tarek; Abo El Dahab, Ali; Kelany, Mohamed; Arafa, Sara; Mokhtar Mohamed Hassan, Osama; Mohamed Badwi, Nermin; Saber Sleem, Ahmad; Ahmed, Hussien; Abdelbadeai, Kholoud; Abozed Abdullah, Mohamed; Lokman, Muhammad Amsyar Auni; Bahar, Suraya; Rady Abdelazeam, Anan; Adelshone, Abdelrahman; Bin Hasnan, Muhammad; Zulkifli, Athirah; Kamarulzamil, Siti Nur Alia; Elhendawy, Abdelaziz; Latif, Aliang; Bin Adnan, Ahmad; Shaharuddin, Shahadatul; Haji Abdul Majid, Aminah Hanum; Amreia, Mahmoud; Al-Marakby, Dina; Salma, Mahmoud; Ismail, Mohamad Jeffrey Bin; Mohd Basir, Elissa Rifhan; Mohd Ali, Citra Dewi; Ata, Aya Yehia; Nasr, Maha; Rezq, Asmaa; Sheta, Ahmed; Tariq, Sherif; Sallam, Abd Elkhalek; Darwish, Abdelrhman KZ; Elmihy, Sohaila; Elhadry, Shady; Farag, Ahmed; Hajeh, Haidar; Abdelaal, Abdelaziz; Aglan, Amro; Zohair, Ahmed; Essam, Mahitab; Moussa, Omar; El-Gizawy, Esraa; Samy, Mostafa; Ali, Safia; El Halawany, Esraa; Ata, Ahmed; El Halawany, Mohamed; Nashat, Mohamed; Soliman, Samar; Elazab, Alaa; Samy, Mostada; Abdelaziz, Mohamed A; Ibrahim, Khaled; Ibrahim, Ahmed Mohamed; Gado, Ammar; Hantour, Usama; Alm Eldeen, Esraa; Loaloa, Mohamed Reda; Abouzaid, Arwa; Ahmed Bahaa Eldin, Mostafa; Hashad, Eman; Sroor, Fathy; Gamil, Doaa; Mahmoud Abdulhakeem, Eman; Zakaria, Mahmoud; Mohamed, Fawzy; Abubakr, Marwan; Ali, Elsayed; Magdy, Hesham; Ramadan, Menna Tallah; Abdelaty Mohamed, Mohamed; Mansour, Salma; Abdul Aziz Amin, Hager; Rabie Mohamed, Ahmed; Saami, Mahmoud; Ahmed Reda Elsayed, Nada; Tarek, Adham; Mohy Eldeen Mahmoud, Sabry; Magdy El Sayed, Islam; Reda, Amira; Yusuf Shawky, Martina; Mousa Salem, Mohammed; Alaa El-Din, Shahinaz; Abdullah Soliman, Noha; Talaat, Muhammed; Alaael-Dein, Shahinaz; Abd Elmoen Elhusseiny, Ahmed; Abdullah, Noha; Elshaar, Mohammed; Abdelfatah Ibraheem, Aya; Abdulaziz, Hager; Kamal Ismail, Mohammed; Hamdy Madkor, Mona; Abdelaty, Mohamed; Mahmoud Abdel-Kader, Sara; Mohamed Salah, Osama; Eldafrawy, Mahmoud; Zaki Eldeeb, Ahmed; Mahmoud Eid, Mostafa; Attia, Attia; Salah El-Dien, Khalid; Shwky, Ayman; Badenjki, Mohamed Adel; Soliman, Abdelrahman; Mahmoud Al Attar, Samaa; Sayed, Farrag; Abdel Sabour, Fahd; Azizeldine, Mohammed G; Shawqi, Muhammad; Hashim, Abdullah; Aamer, Ahmed; Abdelraouf, Ahmed Mahmoud; Abdelshakour, Mahmoud; Ibrahim, Amal; Mahmoud, Basma; Ali Mahmoud, Mohamed; Qenawy, Mostafa; Rashed, Ahmed M; Dahy, Ahmed; Sayed, Marwa; Shamsedine, Ahmed W; Mohamed, Bakeer; Hasan, Ahmad; Saad, Mahmoud M; Abdul Bassit, Khalil; Khalid Abd El-Latif, Nadia; Elzahed, Nada; El Kashash, Ahmed; Bekhet, Nada Mohamed; Hafez, Sarah; Gad, Ahmed; Maher, Mahmoud Elkhadragy; Abd El-Sameea, Ahmed; Hafez, Mohamed; Sabe, Ahmad; Ahmed, Ataa; Shahine, Ahmed; Dawood, Khaled; Gaafar, Shireen; Husseiny, Reem; Aboelmagd, Omnia; Soliman, Ahmed; Mesbah, Nourhan; Emadeldin, Hossam; Al Meligy, Amgad; Bekhet, Amira Hassan; Hasan, Doaa; Alhady, Khaled; Sabe, Ahmad Khaled; Elnajjar, Mahmoud A; Aboelella, Majed; Hamsho, Ward; Hassan, Ihab; Saad, Hala; Abdelazim, Galaleldin; Mahmoud, Hend; Wael, Noha; Kandil, Ahmedali M; Magdy, Ahmed; Said Elkholy, Shimaa; Adel, Badr Eldin; Dabbour, Kareem; Elsherbiney, Saged; Mattar, Omar; Khaled AbdRabou, Abdulshafi; Aly, Mohammed Yahia Mohamed; Geuoshy, Abdelrahman; Elnagar, Ahmedglal; Ahmed, Saraibrahim; Abdelmotaleb, Ibrahem; Saleh, Amr Ahmed; Mohammed Bakry, Hesham; Saeed, Manar; Mahmoud, Shady; Tawfik, Badreldin Adel; Ismail, Samar Adel; Zakaria, Esraay; Gad, Mariam O; Salah Elhelbawy, Mohamed; Bassem, Monica; Maraie, Noha; Medhat Elhadary, Nourhan; Semeda, Nourhan; Rabie Mohamed, Shaza; Bakry, Hesham Mohammed; Essam, Aa; Tarek, Dina; Ashour, Khlood; Elhadad, Alaa; Abdel-Aty, Abdulrahman; Rakha, Ibrahim; Mamdouh Matter, Sara; Abdelhamed, Rasha; Abdelkader, Omar; Hassaan, Ayat; Soliman, Yasmin; Mohamed, Amna; Ghanem, Sara; Amr Mohamed Farouk, Sara; Ibrahim, Eman Mohamed; El-Taher, Esraa; Mostafa, Merna; Mahrous Badr, Mohamed Fawzy; Elsemelawy, Rofida; El-Sawy, Aya; Bakr, Ahmad; Al Rafati, Ahmad Abdel Razaq; Saar, Sten; Reinsoo, Arvo; Seyoum, Nebyou; Worku, Tewodros; Fitsum, Agazi; Tolonen, Matti; Leppäniemi, Ari; Sallinen, Ville; Parmentier, Benogreît; Peycelon, Matthieu; Irtan, Sabine; Dardenne, Sabrina; Robert, Elsa; Maillot, Betty; Courboin, Etienne; Arnaud, Alexis Pierre; Hascoet, Juliette; Abbo, Olivier; Ait Kaci, Amir; Prudhomme, Thomas; Ballouhey, Quentin; Grosos, Céline; Fourcade, Laurent; Cecilia, Tolg; Jean-Francois, Colombani; Helene, Francois-Coridon; Delforge, Xavier; Haraux, Elodie; Dousset, Bertrand; Schiavone, Roberto; Gaujoux, Sebastien; Marret, Jean-Baptiste; Haffreingue, Aurore; Rod, Julien; Renaux-Petel, Mariette; Lecompte, Jean-François; Bréaud, Jean; Gastaldi, Pauline; Taieb, Chouikh; Claire, Raquillet; Anis, Echaieb; Bustangi, Nasir; Lopez, Manuel; Scalabre, Aurelien; Grella, Maria Giovanna; Mariani, Aurora; Podevin, Guillaume; Schmitt, Françoise; Hervieux, Erik; Broch, Aline; Muller, Cecile; Bandoh, Dickson; Abantanga, Francis; Kyereh, Martin; Asumah, Hamza; Appiah, Eric Kofi; Wondoh, Paul; Gyedu, Adam; Dally, Charles; Agbedinu, Kwabena; Amoah, Michael; Yifieyeh, Abiboye; Agbedinu, Kwabena; Owusu, Frank; Amoako-Boateng, Mabel; Dayie, Makafui; Hagan, Richmond; Debrah, Sam; Ohene-Yeboah, Micheal; Clegg-Lampety, Joe-Nat; Etwire, Victor; Dakubo, Jonathan; Essoun, Samuel; Bonney, William; Glover-Addy, Hope; Osei-Nketiah, Samuel; Amoako, Joachim; Adu-Aryee, Niiarmah; Appeadu-Mensah, William; Bediako-Bowan, Antoinette; Dedey, Florence; Ekow, Mattew; Akatibo, Emmanuel; Yakubu, Musah; Kordorwu, Hope Edem Kofi; Asare-Bediako, Kwasi; Tackie, Enoch; Aaniana, Kenneth; Acquah, Emmanuel; Opoku-Agyeman, Richard; Avoka, Anthony; Kusi, Kwasi; Maison, Kwame; Gyamfi, Frank Enoch; Naa Barnabas, Gandau; Abdul-Latif, Saiba; Taah Amoako, Philip; Davor, Anthony; Dassah, Victor; Dagoe, Enoch; Kwakyeafriyie, Prince; Akoto, Elliot; Ackom, Eric; Mensah, Ekow; Atkins, Ebenezer Takyi; Coompson, Christian Lari; Ivros, Nikolaos; Ferousis, Christoforos; Kalles, Vasileios; Agalianos, Christos; Kyriazanos, Ioannis; Barkolias, Christos; Tselos, Angelos; Tzikos, Georgios; Voulgaris, Evangelos; Lytras, Dimitrios; Bamicha, Athanasia; Psarianos, Kyriakos; Stefanopoulos, Anastasios; Patoulias, Ioannis; Sfougaris, Dimitrios; Valioulis, Ioannis; Balalis, Dimitrios; Korkolis, Dimitrios; Manatakis, Dimitrios K; Kyrou, Georgios; Karabelias, Georgios; Papaskarlatos, Iason-Antonios; Konstantina, Kolonia; Zampitis, Nikolaos; Germanos, Stylianos; Papailia, Aspasia; Theodosopoulos, Theodosios; Gkiokas, Georgios; Mitroudi, Magdalini; Panteli, Christina; Feidantsis, Thomas; Farmakis, Konstantinos; Kyziridis, Dimitrios; Ioannidis, Orestis; Parpoudi, Styliani; Gemenetzis, Georgios; Parasyris, Stavros; Anthoulakis, Christos; Nikoloudis, Nikolaos; Margaritis, Michail; Aguilera-Arevalo, Maria-Lorena; Coyoy-Gaitan, Otto; Rosales, Javier; Tale, Luis; Soley, Rafael; Barrios, Emmanuel; Rodriguez, Servio Tulio Torres; Paz Galvez, Carlos; Herrera Cruz, Danilo; Sanchez Rosenberg, Guillermo; Matheu, Alejandro; Cohen, David Monterroso; Paul, Marie; Charles, Angeline; Lam, Justin Chak Yiu; Yeung, Man Hon Andrew; Fok, Chi Ying Jacquelyn; Li, Ka Hin Gabriel; Lai, Anthony Chuk-Him; Cheung, Yuk Hong Eric; Wong, Hong Yee; Leung, Ka Wai; Lee, Tien Seng Bryan; Lam, Wai Him; Dao, Weihei; Kwok, Stephanie Hiu-wai; Chan, Tsz-Yan Katie; Ng, Yung Kok; Mak, Twc; Foo, Chi Chung; Yang, James; Bhatnagar, Ankur; Upadhyaya, Vijaid; Muddebihal, Uday; Dar, Wasim; Janardhan, Kc; Aruldas, Neerav; Adella, Fidelis Jacklyn; Rulie, Anthonius Santoso; Iskandar, Ferdy; Setiawan, Jonny; Evajelista, Cicilia Viany; Natalie, Hani; Suyadi, Arlindawati; Gunawan, Rudy; Karismaningtyas, Herlin; Mata, Lusi Padma Sulistianingsih; Andika, Ferry Fitriya Ayu; Hasanah, Afifatun; Widiastini, T Ariani; Purwaningsih, Nurlaila Ayu; Mukin, Annisa Dewi Fitriana; Rahmah, Dina Faizatur; Nurqistan, Hazmi Dwinanda; Arsyad, Hasbi Maulana; Adhitama, Novia; Jeo, Wifanto Saditya; Sutandi, Nathania; Clarissa, Audrey; Gultom, Phebe Anggita; Billy, Matthew; Haloho, Andreass; Johanna, Nadya; Lee, Felix; Radin Dorani, Radin Mohd Nurrahman; Glynn, Martha; Alherz, Mohammad; Goh, Wennweoi; Shiwani, Haaris A; Sproule, Lorraine; Conlon, Kevin C; Bala, Miklosh; Kedar, Asaf; Turati, Luca; Bianco, Federica; Steccanella, Francesca; Gallo, Gaetano; Trompetto, Mario; Clerico, Giuseppe; Papandrea, Matteo; Sammarco, Giuseppe; Sacco, Rosario; Benevento, Angelo; Giavarini, Luisa; Giglio, Mariano Cesare; Bucci, Luigi; Pagano, Gianluca; Sollazzo, Viviana; Peltrini, Roberto; Luglio, Gaetano; Birindelli, Arianna; Di Saverio, Salomone; Tugnoli, Gregorio; Paludi, Miguel Angel; Mingrone, Pietro; Pata, Domenica; Selvaggi, Francesco; Selvaggi, Lucio; Pellino, Gianluca; Di Martino, Natale; Curletti, Gianluca; Aonzo, Paolo; Galleano, Raffaele; Berti, Stefano; Francone, Elisa; Boni, Silvia; Lorenzon, Laura; lo Conte, Annalisa; Balducci, Genoveffa; Confalonieri, Gianmaria; Pesenti, Giovanni; Gavagna, Laura; Vasquez, Giorgio; Targa, Simone; Occhionorelli, Savino; Andreotti, Dario; Pata, Giacomo; Armellini, Andrea; Chiesa, Deborah; Aquilino, Fabrizio; Chetta, Nicola; Picciariello, Arcangelo; Abdelkhalek, Mohamed; Belli, Andrea; De Franciscis, Silvia; Bigaran, Annamaria; Favero, Alessandro; Basso, Stefano MM; Salusso, Paola; Perino, Martina; Mochet, Sylvie; Sasia, Diego; Riente, Francesco; Migliore, Marco; Merlini, David; Basilicò, Silvia; Corbellini, Carlo; Lazzari, Veronica; Macchitella, Yuri; Bonavina, Luigi; Angelieri, Daniele; Coletta, Diego; Falaschi, Federica; Catani, Marco; Reali, Claudia; Malavenda, Mariastella; Del Basso, Celeste; Ribaldi, Sergio; Coletti, Massimo; Natili, Andrea; Depalma, Norma; Iannone, Immacolata; Antoniozzi, Angelo; Rossi, Davide; Gui, Daniele; Perrotta, Gerardo; Ripa, Matteo; Giardino, Francesco Ruben; Foco, Maurizio; Vicario, Erika; Coccolini, Federico; Nita, Gabriela Elisa; Leone, Nicoletta; Bondurri, Andrea; Maffioli, Anna; Simioni, Andrea; De Boni, Davide; Pasquali, Sandro; Goldin, Elena; Vendramin, Elena; Ciccioli, Eleonora; Tedeschi, Umberto; Bortolasi, Luca; Violi, Paola; Campagnaro, Tommaso; Conci, Simone; Lazzari, Giovanni; Iacono, Calogero; Gulielmi, Alfredo; Manfreda, Serena; Rinaldi, Anna; Ringressi, Maria Novella; Brunoni, Beatrice; Salamone, Giuseppe; Mangiapane, Mirko; De Marco, Paolino; La Brocca, Antonella; Tutino, Roberta; Silvestri, Vania; Licari, Leo; Fontana, Tommaso; Falco, Nicolò; Cocorullo, Gianfranco; Shalaby, Mostafa; Sileri, Pierpaolo; Arcudi, Claudio; Bsisu, Isam; Aljboor, Khaled; Abusalem, Lana; Alnusairat, Aseel; Qaissieh, Ahmad; Al-Dakka, Emad; Ababneh, Ali; Halhouli, Oday; Yusufali, Taha; Mohammed, Hussein; Lando, Justus; Parker, Robert; Ndegwa, Wairimu; Jokubauskas, Mantas; Gribauskaite, Jolanta; Kuliavas, Justas; Dulskas, Audrius; Samalavicius, Narimantas E; Jasaitis, Kristijonas; Parseliunas, Audrius; Nevieraite, Viktorija; Montrimaite, Margarita; Slapelyte, Evelina; Dainius, Edvinas; Riauka, Romualdas; Dambrauskas, Zilvinas; Subocius, Andrejus; Venclauskas, Linas; Gulbinas, Antanas; Bradulskis, Saulius; Kasputyte, Simona; Mikuckyte, Deimante; Kiudelis, Mindaugas; Jankus, Tomas; Petrikenas, Steponas; Pažuskis, Matas; Urniežius, Zigmantas; Vilčinskas, Mantas; Banaitis, Vincas Jonas; Gaižauskas, Vytautas; Grisin, Edvard; Mazrimas, Povilas; Rackauskas, Rokas; Drungilas, Mantas; Lagunavicius, Karolis; Lipnickas, Vytautas; Majauskyté, Dovilè; Jotautas, Valdemaras; Abaliksta, Tomas; Uščinas, Laimonas; Simutis, Gintaras; Ladukas, Adomas; Danys, Donatas; Laugzemys, Erikas; Mikalauskas, Saulius; Zdanyte Sruogiene, Elena; Višinskas, Petras; Žilinskienė, Reda; Dragatas, Deividas; Burmistrovas, Andrius; Tverskis, Zygimantas; Vaicius, Arturas; Mazelyte, Ruta; Zadoroznas, Antanas; Kaselis, Nerijus; Žiubrytė, Greta; Rahantasoa, Finaritra Casimir Fleur Prudence; Samison, Luc Hervé; Rasoaherinomenjanahary, Fanjandrainy; Tolotra, Todisoa Emmanuella Christina; Mukuzunga, Cornelius; Kwatiwani, Chimwemwe; Msiska, Nelson; Chai, Feng Yih; Asilah, Siti Mohd Desa; Syibrah, Khuzaimah Zahid; Chin, Pui Xin; Salleh, Afizah; Riswan, Nur Zulaika; Roslani, April Camilla; Chong, Hoong-Yin; Aziz, Nora Abdul; Poh, Keat-Seong; Chai, Chu-Ann; Kumar, Sandip; Taher, Mustafa Mohammed; 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Rivista: THE LANCET INFECTIOUS DISEASES
Keywords: Infectious Diseases, surgical site, infection, gastrointestinal surgery
Abstract in inglese: Background: Surgical 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. Methods: This 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. Findings: Between 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). Interpretation: Countries 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. Funding: DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant.
Digital Object Identifier (DOI): 10.1016/S1473-3099(18)30101-4
Handle: http://hdl.handle.net/11392/2384592
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