Benchmarking for surgical site infections among gastrointestinal surgeries and related risk factors: multicenter study in Kuwait

Abstract

Benchmarking for surgical site infections among gastrointestinal surgeries and related risk factors: multicenter study in Kuwait Wafaa S Hamza,1,2 Mona F Salama,1,3 Samar S Morsi,1,4 Naglaa M Abdo,1,5 Mariam A Al-Fadhli1 1Infection Control Directorate, Ministry of Health, Kuwait City, Kuwait; 2Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt; 3Department of Microbiology and Medical Immunology, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 4Department of Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt; 5Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt Purpose: To measure surgical site infection (SSI) rates among gastrointestinal surgeries and to identify the associated risk factors. Patients and methods: We conducted a multicenter, retrospective, surveillance-based study of adults undergoing gastric, colon, and small bowel (SB) procedures from January to December 2016. Univariate and multivariate analyses were conducted to determine the predictive variables in each surgery. Results: In total, 71 of 2,099 patients developed SSI – 0.8%, 19.8%, and 10.8% following gastric, colon, and SB surgeries, respectively. In gastric surgery, the risk factors identified by univariate analysis were age, duration, wound class, risk index, emergency, and scope use (P<0.05). Logistic regression analysis revealed that the laparoscopic approach was the only significant predictor, with an inverse relationship of SSI rate vs open gastric surgery (P<0.05). Prolonged duration was a significant risk factor for developing SSI in colon surgery, and emergency was a significant risk for development of SSI in SB surgery. Gram-negative bacilli were the main causative pathogens, with a high percentage of multidrug-resistant organisms. Conclusion: Variances in SSI rates and risk factors among gastric, colon, and SB surgery were detected. The use of an endoscope in gastric surgeries exhibited a protective effect against the development of SSI. The reduction of the SSI rate can be achieved by targeted preventive interventions for the identified risk factors. Keywords: surveillance, health care-associated infections, laparoscope, gastric surgery, Gram-negative bacilli, post-discharge surveillance