title: Risk factors for prediction of surgical site infections in "clean surgery".
abstract: BACKGROUND
  The aim of this study was to determine the risk factors of surgical site infections (SSI) in clean surgery and to identify high- and low-risk patients from whom efficacy of the antibiotic prophylaxis was analyzed.
  
  
  METHODS
  From June 1982 to September 1996, a database was established from 3 prospective multicenter randomized studies, containing information of 5798 patients who underwent abdominal noncolorectal surgery. Multivariate analysis was performed using nonconditional logistic regression expressed as an odds ratio (OR).
  
  
  RESULTS
  A total of 2374 patients underwent a clean surgery. An antibiotic prophylaxis was administered to 1943 patients (81.8%). A multivariate analysis was performed including only preoperative factors and disclosed 3 independent factors: cirrhosis (OR, 2.8; 95% CI: 1.6-12.8), other disease (OR, 2.7; 95% CI: 1.3-5.8), and preoperative urinary catheter (OR, 2.1; 95% CI: 1.1-4.6). A risk score for SSI was constructed: -4.9 + (1.5 x cirrhosis++) + (other disease++) + (0.8 x preoperative urinary catheter++) (++ = 0 if absent or 1 if present). The study included 1 group of patients having no risk factors for SSI with a score below -4.5 (S1R-) and 1 group of patients having 1 or more risk factors for SSI with a score over -4.5 (S1R+). Antibiotic prophylaxis did not reduce the infectious complication rate in the S1R- group, whereas, in the S1R+ group, it reduced significantly the rate of SSI and of parietal infectious complications by 58% and 69%, respectively.
  
  
  CONCLUSIONS
  Antibiotic prophylaxis in clean abdominal surgery was effective in high-risk patients. Urinary catheter must be avoided.
authors.affiliation: Service de Chirurgie Digestive, Centre Hospitalier et Universitaire Angers, 4 Rue Larrey, 49933 Angers Cedex 9, France. pessauxpchuangers@yahoo.fr
authors.forename: Patrick
authors.initials: P
authors.lastname: Pessaux
authors.forename: David
authors.initials: D
authors.lastname: Atallah
authors.forename: Emilie
authors.initials: E
authors.lastname: Lermite
authors.forename: Simon
authors.initials: S
authors.lastname: Msika
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Hay
authors.forename: Yves
authors.initials: Y
authors.lastname: Flamant
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Arnaud
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D016009:Chi-Square Distribution; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*