title: Enhanced identification of postoperative infections among inpatients.
abstract: We evaluated antimicrobial exposure, discharge diagnoses, or both to identify surgical site infections (SSI). This retrospective cohort study in 13 hospitals involved weighted, random samples of records from 8,739 coronary artery bypass graft (CABG) procedures, 7,399 cesarean deliveries, and 6,175 breast procedures. We compared routine surveillance to detection through inpatient antimicrobial exposure (> 9 days for CABG, > 2 days for cesareans, and > 6 days for breast procedures), discharge diagnoses, or both. Together, all methods identified SSI after 7.4% of CABG, 5.0% of cesareans, and 2.0% of breast procedures. Antimicrobial exposure had the highest sensitivity, 88%-91%, compared with routine surveillance, 38%-64%. Diagnosis codes improved sensitivity of detection of antimicrobial exposure after cesareans. Record review confirmed SSI after 31% to 38% of procedures that met antimicrobial surveillance criteria. Sufficient antimicrobial exposure days, together with diagnosis codes for cesareans, identified more postoperative SSI than routine surveillance methods. This screening method was efficient, readily standardized, and suitable for most hospitals.
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, USA. deborah.yokoe@channing.harvard.edu
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Yokoe
authors.forename: Gary A
authors.initials: GA
authors.lastname: Noskin
authors.forename: Susan M
authors.initials: SM
authors.lastname: Cunnigham
authors.forename: Gianna
authors.initials: G
authors.lastname: Zuccotti
authors.forename: Theresa
authors.initials: T
authors.lastname: Plaskett
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Olsen
authors.forename: Jerome I
authors.initials: JI
authors.lastname: Tokars
authors.forename: Steven
authors.initials: S
authors.lastname: Solomon
authors.forename: Trish M
authors.initials: TM
authors.lastname: Perl
authors.forename: Sara E
authors.initials: SE
authors.lastname: Cosgrove
authors.forename: Richard S
authors.initials: RS
authors.lastname: Tilson
authors.forename: Maurice
authors.initials: M
authors.lastname: Greenbaum
authors.forename: David C
authors.initials: DC
authors.lastname: Hooper
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Sands
authors.forename: John
authors.initials: J
authors.lastname: Tully
authors.forename: Loreen a
authors.initials: La
authors.lastname: Herwaldt
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Diekema
authors.forename: Edward S
authors.initials: ES
authors.lastname: Wong
authors.forename: Michael
authors.initials: M
authors.lastname: Climo
authors.forename: Richard
authors.initials: R
authors.lastname: Platt
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002585:Cesarean Section / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007297:Inpatients; D016462:Mammaplasty / Q000009:adverse effects; D010351:Patient Discharge; D011159:Population Surveillance / Q000379:methods*; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents