Enhanced identification of postoperative infections among inpatients.
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.
Yokoe
Deborah S
DS
Brigham and Women's Hospital, Boston, Massachusetts, USA. deborah.yokoe@channing.harvard.edu
Noskin
Gary A
GA
Cunnigham
Susan M
SM
Zuccotti
Gianna
G
Plaskett
Theresa
T
Fraser
Victoria J
VJ
Olsen
Margaret A
MA
Tokars
Jerome I
JI
Solomon
Steven
S
Perl
Trish M
TM
Cosgrove
Sara E
SE
Tilson
Richard S
RS
Greenbaum
Maurice
M
Hooper
David C
DC
Sands
Kenneth E
KE
Tully
John
J
Herwaldt
Loreen a
La
Diekema
Daniel J
DJ
Wong
Edward S
ES
Climo
Michael
M
Platt
Richard
R
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
D000900:Anti-Bacterial Agents