Risk of surgical site infection and efficacy of antibiotic prophylaxis: a cohort study of appendectomy patients in Thailand.
BACKGROUND
No data currently exist about use of antibiotics to prevent surgical site infections (SSI) among patients undergoing appendectomy in Thailand. We therefore examined risk factors, use, and efficacy of prophylactic antibiotics for surgical site infection SSI among patients with uncomplicated open appendectomy.


METHODS
From July 1, 2003 to June 30, 2004 we conducted a prospective cohort study in eight hospitals in Thailand. We used the National Nosocomial Infection Surveillance (NNIS) system criteria to identify SSI associated with appendectomy. We used logistic regression analysis to obtain relative risk estimates for predictors of SSI.


RESULTS
Among 2139 appendectomy patients, we identified 26 SSIs, yielding a SSI rate of 1.2 infections/100 operations. Ninety-two percent of all patients (95% CI, 91.0-93.3) received antibiotic prophylaxis. Metronidazole and gentamicin were the two most common antibiotic agents, with a combined single dose administered in 39% of cases. In 54% of cases, antibiotic prophylaxis was administered for one day. We found that a prolonged duration of operation was significantly associated with an increased SSI risk. Antibiotic prophylaxis was significantly associated with a decreased risk of SSI regardless of whether the antibiotic was administered preoperatively or intraoperatively. Compared with no antibiotic prophylaxis, SSI relative risks for combined single-dose of metronidazole and gentamicin, one-day prophylaxis, and multiple-day antibiotic prophylaxis were 0.28 (0.09-0.90), 0.30 (0.11-0.88) and 0.32 (0.10-0.98), respectively.


CONCLUSIONS
Single-dose combination of metronidazole and gentamicin seems sufficient to reduce SSIs in uncomplicated appendicitis patients despite whether the antibiotic was administered preoperatively or intraoperatively.
Kasatpibal
Nongyao
N
Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg and Aarhus, Denmark. nongyaok2003@yahoo.com
Nørgaard
Mette
M
Sørensen
Henrik Toft
HT
Schønheyder
Henrik Carl
HC
Jamulitrat
Silom
S
Chongsuvivatwong
Virasakdi
V
D000293:Adolescent; D000328:Adult; D019072:Antibiotic Prophylaxis; D001062:Appendectomy / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use*; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D013785:Thailand / Q000453:epidemiology
D005839:Gentamicins; D008795:Metronidazole