title: Bacteria of preoperative urinary tract infections contaminate the surgical fields and develop surgical site infections in urological operations.
abstract: BACKGROUND
  The risk factors for surgical site infection (SSI) following urological operations have not been clearly identified, although the presence of a preoperative urinary tract infection (UTI) is thought to be one risk factor. We studied potential risk factors to clarify when and how bacteria contaminate wounds and SSI develop.
  
  
  METHODS
  Objects of the present study were patients with SSI after open urological operations that were performed at the Department of Urology, Miyazaki Medical College Hospital, University of Miyazaki, Kiyotake, Miyazaki, Japan, during the period between June 1999 and December 2000. Endourological operations, operations on children and short operations of less than 2 h duration were excluded. Patients were screened for the presence of UTI before the operation and subcutaneous swabs for culture were collected at the end of the operation by brushing with a sterile cotton-swab just before skin closure.
  
  
  RESULTS
  Surgical site infections occurred in 20 of 134 patients. Bacteria from the subcutaneous swabs were detected in 15 (75.0%) of the patients with SSI. All patients received antimicrobial prophylaxis (AMP), but bacteria from the subcutaneous swabs of patients with SSI were less susceptible to the agents (20.0%). Preoperative UTI were observed in 11 (55.0%) of the patients with SSI. In these patients, four had the same species of bacteria detected from urine, swab and wound, three had the same species from swab and wound and one had the same species from urine and wound.
  
  
  CONCLUSIONS
  Preoperative UTI was the most important risk factor for SSI following urological operations. It is most likely that the bacteria in the urine contaminated the surgical fields and the AMP resistant strains produced SSI.
authors.affiliation: Department of Urology, Miyazaki Medical College, University of Miyazaki, Kiyotake, Miyazaki, Japan. hamaryo@med.miyazaki-u.ac.jp
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Hamasuna
authors.forename: Hironori
authors.initials: H
authors.lastname: Betsunoh
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sueyoshi
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Yakushiji
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Tsukino
authors.forename: Masafumi
authors.initials: M
authors.lastname: Nagano
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Takehara
authors.forename: Yukio
authors.initials: Y
authors.lastname: Osada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D002511:Cephalosporins / Q000008:administration & dosage; D003428:Cross Infection / Q000382:microbiology* / Q000517:prevention & control; D004926:Escherichia coli / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000150:complications / Q000175:diagnosis; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000150:complications / Q000175:diagnosis; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012307:Risk Factors; D013048:Specimen Handling; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000382:microbiology* / Q000517:prevention & control; D014552:Urinary Tract Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D014556:Urine / Q000382:microbiology; D013520:Urologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins