A cohort study in The Lancet Infectious Diseases quantified the international burden of surgical site infection after gastrointestinal surgery.
Here are five things to know:
1. This prospective multi-center cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within two-week time periods at any healthcare facility. Countries with participating centers were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index.
2. Between Jan. 4, 2016, and July 31, 2016, 13,265 records were submitted for analysis, including 12,539 patients from 343 hospitals in 66 countries. Of these patients, 7,339 —58.5 percent —were from high-HDI countries; 3,918 —31.2 percent —were from middle-HDI countries; and 1,282 — 10.2 percent — were from low-HDI countries.
3. In all, 1,538 patients — 12.3 percent — had SSI within 30 days of surgery. The highest SSI incidence in each HDI group was after dirty surgery. Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI.
4. Of 610 patients with an SSI and microbiology culture result, 132 had an infection resistant to the prophylactic antibiotic used to treat it. Resistant infections were detected in 16.6 percent of patients in high-HDI countries, in 19.8 percent of 187 patients in middle-HDI countries, and in 35.9 percent of 128 patients in low-HDI countries.
5. Nations with a low HDI bore a disproportionately large share of the SSI burden after gastrointestinal surgery. Countries with a low HDI may have higher rates of antibiotic resistance as well. The study authors suggest that more research is needed to reduce preventable SSIs.
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