Incidence of and risk factors for surgical site infection after colorectal surgery: A multiple-center prospective study of 3,663 consecutive patients in China

Tie-Ying Hou; Hui-Quan Gan; Jing-Fang Zhou; Ya-Jie Gong; Liu-Yi Li; Xin-Qiang Zhang; Yue Meng; Jie-Rong Chen; Wei-Jiang Liu; Long Ye; Xiao-Xiao Wang; Yun-Hu Zhao; Yu Zhang

doi:10.1016/j.ijid.2020.05.124

Incidence of and risk factors for surgical site infection after colorectal surgery: A multiple-center prospective study of 3,663 consecutive patients in China

Int J Infect Dis. 2020 Jul:96:676-681. doi: 10.1016/j.ijid.2020.05.124. Epub 2020 Jun 4.

Authors

Affiliations

¹ Department of Laboratory, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China; Guangdong Nosocomial Infection Control and Quality Improvement Center, China.
² Department of Laboratory, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China.
³ Department of Infection Control, Peking University First Hospital, Beijing, China.
⁴ Department of Laboratory, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China; Guangdong Nosocomial Infection Control and Quality Improvement Center, China. Electronic address: jade_0801@sina.com.

PMID: 32505873
DOI: 10.1016/j.ijid.2020.05.124

Abstract

Background: Surgical site infection (SSI) after colorectal surgery (CRS) remains a significant problem for its negative clinical outcomes. However, it is poorly understood in China. This study aims to investigate the incidence, risk factors and microbiology of SSI after CRS.

Methods: A nationwide prospective multicenter design was applied. Patients in 19 Chinese hospitals from 2015 to 2018 were prospectively monitored for SSI after CRS. Demographic data, hospital characteristics, and potential perioperative risk factors were collected and analyzed, using univariate and multivariate logistic regression models.

Results: Among 3,663 study participants, 134(3.66%) episodes of SSI were identified. The incidence rate of SSI decreased from 5.9 infections per 100 procedures in 2015 to 3.1 infections per 100 procedures in 2018 (incidence rate ratio, 0.52; 95% CI, 0.28-0.94). The SSI rates were 1.88, 4.15, 6.27 and 11.58 per 100 operations for the National Nosocomial Infections Surveillance system (NNIS) risk index categories of 0, 1, and 2 or 3, respectively. Escherichia coli (54/134, 40.3%) and Klebsiella pneumoniae (10/134, 7.5%) were the most frequently isolated microorganisms. A high prevalence of antibiotic resistance were observed in our study, with rates of extended spectrum beta-lactamase-producing or carbapenem-resistant Escherichia coli and Klebsiella pneumonia of 50.0%(27/54) and 30.0%(3/10) respectively. Preoperative hospital stay ≥ 48h (OR=2.28, 95% CI: 1.03-5.02, P=0.042) and contaminated or dirty wound (OR=3.38, 95% CI: 1.88-6.06, P=4.50×10^-5) were significantly associated with increasing risk of SSI after CRS.

Conclusion: A statistically significant but modest decrease in the incidence rate of CRS SSI over the 4-year study period was observed in this study. Noticeably, the relatively high rates of multidrug-resistant pathogens causing SSI after CRS should be alert, while more studies with large population are needed due to the small number of isolates identified in our survey.

Keywords: China; Colorectal surgery; Prevalence; Risk factor; Surgical site infection.

Publication types

Multicenter Study

MeSH terms

Adult
Aged
Bacteria / classification
Bacteria / genetics
Bacteria / isolation & purification*
Bacterial Infections / etiology*
Bacterial Infections / microbiology
China / epidemiology
Colorectal Surgery / adverse effects*
Cross Infection / epidemiology*
Cross Infection / etiology
Cross Infection / microbiology
Female
Humans
Incidence
Length of Stay
Logistic Models
Male
Middle Aged
Prospective Studies
Risk Factors
Surgical Wound Infection / epidemiology*
Surgical Wound Infection / etiology
Surgical Wound Infection / microbiology