Trends in the incidence of superficial versus deep-organ/space surgical site infection in a tertiary hospital



      The frequency of surgical site infection (SSI) in western countries shows a variable tendency because of technical improvements on one hand and an aging and an increasingly fragile population on the other. Our hypothesis is that there is no time trend in the incidence of SSI. The objective of this article was to assess incidence trends of SSI, after adjusting for confounders and variables associated with SSI frequency.


      We studied trends of SSI over 13 y in our hospital in a cohort (26,810 patients), evaluating the factors associated with SSI (superficial or deep-organ/space), in a bivariate and multivariate analysis.


      Global SSI was 4.8%, most of which was superficial (3.4%). We obtained two well-adjusted equations (area under receiver operating characteristic curves: 0.77 and 0.78, with nine variables). Main risk factors for SSI were duration of surgery (>60 min), infection on hospital admission, emergency and vascular surgery. After controlling for all risk factors, we found that superficial SSI showed a significant reduction (75) yearly, but deep-organ/space SSI rates remained stable over time.


      We obtained a 7% yearly reduction in superficial SSI and no variation for deep-organ/space SSI after adjusting for eight risk and confounding factors.


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        • Gawande A.A.
        • Kwaan M.R.
        • Regenbogen S.E.
        • Lipsitz S.A.
        • Zinner M.J.
        An Apgar score for surgery.
        J Am Coll Surg. 2007; 204: 201
        • Neumayer L.
        • Hosokawa P.
        • Itani K.
        • El-Tamer M.
        • Henderson W.G.
        • Khuri S.F.
        Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study.
        J Am Coll Surg. 2007; 204: 1178
        • Malone D.L.
        • Genuit T.
        • Tracy J.K.
        • Gannon C.
        • Napolitano L.M.
        Surgical site infections: reanalysis of risk factors.
        J Surg Res. 2002; 103: 89
        • Russo P.L.
        • Spelman D.W.
        A new surgical-site infection risk index using risk factors identified by multivariate analysis for patients undergoing coronary artery bypass graft surgery.
        Infect Control Hosp Epidemiol. 2002; 23: 372
        • Owens C.D.
        • Stoessel K.
        Surgical site infections: epidemiology, microbiology and prevention.
        J Hosp Infect. 2008; 70: 3
        • Vilar-Compte D.
        • Garcia-Pineda B.
        • Sandoval-Hernandez S.
        • Castillejos A.
        Infecciones de sitio quirúrgico. De la patogénesis a la prevención [Surgical site infections: From pathogenesis to prevention].
        Enf Inf Microbiol. 2008; 28 ([in Spanish]): 24
        • Leo A.
        • Piffer S.
        • Ricci F.
        • et al.
        Surgical site infections in an Italian surgical ward: a prospective study.
        Surg Infect. 2009; 10: 533
        • Seal L.A.
        • Paul-Cheadle D.
        A system approach to preoperative surgical patient skin preparation.
        A J Infect Control. 2004; 32: 57
        • Milstone A.M.
        • Passaretti C.L.
        • Perl T.M.
        Chlorhexidine: Expanding the armamentarium for infection control and prevention.
        Clin Infect Dis. 2008; 46: 274
        • Paocharoen V.
        • Mingmalairak C.
        • Apisarnthanarak A.
        Comparison of surgical infection after preoperative skin preparation with 4% chlorhexidine and povidone iodine: a prospective randomized trial.
        J Med Assoc Thai. 2009; 92: 898
        • Edmiston Jr., C.E.
        • Krepel C.J.
        • Seabrook G.R.
        • Lewis B.D.
        • Brown K.R.
        • Towne J.B.
        Preoperative shower revisited: can high topical antiseptic level be achieved on the skin surface before surgical admission?.
        J Am Coll Surg. 2008; 207: 233
        • Darouiche R.O.
        • Wall M.J.
        • Itani K.M.
        • et al.
        Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis.
        N Engl J Med. 2010; 362: 18
        • Dohmen P.M.
        • Gabbieri D.
        • Weymann A.
        • Linneweber J.
        • Konertz W.
        Reduction in surgical site infection in patients treated with microbial sealant prior to coronary artery bypass graft surgery: a case-control study.
        J Hosp Infect. 2009; 72: 119
        • Herruzo-Cabrera R.
        • Vizcaino-Alcaide M.J.
        • Fernandez-Aceñero M.J.
        Usefulness of an alcohol solution of N-duopropenide for the surgical antisepsis of the hands compared with handwashing with iodine-povidone and chlorhexidine: clinical essay.
        J Surg Res. 2000; 94: 6
        • Tanner J.
        • Woodings D.
        • Moncaster K.
        Preoperative hair removal to reduce surgical site infection (review).
        Cochrane Libr. 2008;
        • Kao L.S.
        • Meeks D.
        • Moyer V.A.
        • Lally K.P.
        Peri-operative glycaemic control regimens for preventing surgical site infections in adults (review).
        Cochrane Libr. 2009;
        • Melling A.C.
        • Ali B.
        • Scott E.M.
        • Leaper D.J.
        Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomized controlled trial.
        Lancet. 2001; 358: 876
        • Gagliardi A.R.
        • Fenech D.
        • Eskicioglu C.
        • Nathens A.B.
        • McLeod R.
        Factors influencing antibiotic prophylaxis for surgical site infection prevention in general surgery: a review of the literature.
        Can J Surg. 2009; 52: 481
        • Anderson D.J.
        • Kaye K.S.
        • Classen D.
        • et al.
        Strategies to prevent surgical site infections in acute care hospitals.
        Infect Control Hosp Epidemiol. 2008; 29: 51
        • de Lissovoy G.
        • Fraeman K.
        • Hutchins V.
        • Murphy D.
        • Song D.
        • Vaughn B.B.
        Surgical site infection: incidence and impact on hospital utilization and treatment costs.
        Am J Infect Control. 2009; 37: 387
        • Sparling K.W.
        • Ryckman F.C.
        • Schoettker P.J.
        • et al.
        Financial impact of failing to prevent surgical site infections.
        Qual Manag Health Care. 2007; 16: 219
        • Grupo de trabajo Proyecto EPINE
        [EPINE Study Workgroup: Prevalence of Nosocomial Infections in Spanish Hospitals 1991-2005].
        Sociedad Española de Higiene y Medicina Preventiva Hospitalaria, Madrid, Spain2006 ([in Spanish])
        • Garner J.S.
        • Jarvis W.R.
        • Emori T.G.
        • Horan T.C.
        • Hughes J.M.
        CDC definitions for nosocomial infections 1988.
        Am J Infect Control. 1988; 16: 128
        • Horan T.C.
        • Gaynes R.P.
        • Martone W.J.
        • Jarvis W.R.
        • Emori T.G.
        CDC definitions of nosocomial surgical site infections, 1992. A modification of CDC definitions of surgical wound infections.
        Infect Control Hosp Epidemiol. 1992; 13: 606
        • Haridas M.
        • Malangoni M.A.
        Predictive factors for surgical site infection in general surgery.
        Surgery. 2008; 144: 496
        • Mahmoud N.N.
        • Turpin R.S.
        • Yang G.
        • Saunders W.B.
        Impact of surgical site infections on length of stay and cost in selected colorectal procedures.
        Surg Infect (Larchmt). 2009; 10: 539
        • Konvalinka A.
        • Errett L.
        • Fong I.W.
        Impact of treating Staphylococcus aureus nasal carriers on wound infections in cardiac surgery.
        J Hosp Infect. 2006; 64: 162
        • Rijen M.
        • Wenzel R.
        • Kluytmans J.
        Mupirocin ointment for preventing Staphylococcus aureus infections in nasal carriers (review).
        Cochrane Libr. 2009;
        • Bode L.G.M.
        • Kluytmans J.A.J.W.
        • Wertheim H.F.L.
        • et al.
        Preventing surgical-site infections in nasal carriers of Staphylococcus aureus.
        N Eng J Med. 2010; 362: 9