title: Surgical site infections following bariatric surgery in community hospitals: a weighty concern?
abstract: BACKGROUND
  Although obesity is a well-known risk factor for surgical site infection (SSI), specific risk factors for SSI among obese patients undergoing bariatric surgery (BS) have not been well-defined.
  
  
  METHODS
  We performed a prospective cohort study on patients who underwent BS at nine community hospitals in the USA between 7/1/2007 and 12/31/2008. Each patient had the following data recorded: National Nosocomial Infection Surveillance (NNIS) risk index; the choice, timing, and dose of antibiotic prophylaxis; age; body mass index; and duration of surgery. NNIS criteria were used to define SSI. Cases were detected during the post-operative hospital stay, on readmission to hospital within 30 days of the procedure and by post-discharge surveillance.
  
  
  RESULTS
  A total of 2,012 patients were included in the study. The majority of procedures were laparoscopic (82%). The overall rate of SSI was 1.4% (28/2012). Patients who received vancomycin surgical prophylaxis were more likely to develop SSI than patients who received other antibiotics (relative risk [RR] = 9.4; 95% confidence interval [CI] = 3.1-26.1; p = 0.005). More specifically, patients who received vancomycin prophylaxis as a single agent at a dose less than 2 g were more likely to develop SSI than patients who received other antibiotic regimens (RR = 7.1; 95% CI = 1.9-23.8; p = 0.035).
  
  
  CONCLUSIONS
  Inadequate dosing of vancomycin prophylaxis prior to BS is associated with increased risk of SSI. If vancomycin is used for prophylaxis, the appropriate dose should be calculated using actual bodyweight rather than lean bodyweight in accordance with Infectious Disease Society of America recommendations.
authors.affiliation: Duke Infection Control Outreach Network (DICON), Duke University Medical Center, DUMC 3605, Durham, NC 27710, USA. JoshuaF@adhb.govt.nz
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Freeman
authors.forename: Deverick J
authors.initials: DJ
authors.lastname: Anderson
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Hartwig
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sexton
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000453:epidemiology* / Q000517:prevention & control; D050110:Bariatric Surgery; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin