title: Incidence and modifiable risk factors of surveillance of surgical site infections in Egypt: a prospective study.
abstract: BACKGROUND
  Surgical site infections (SSIs) contribute significantly to patient morbidity and mortality and exhaust health care system resources. The main objectives of the study were to describe the incidence rates of SSIs among patients undergoing urologic or cardiothoracic surgeries, the associated risk factors, and the common causative etiologies found at Alexandria University Hospital in Egypt.
  
  
  METHODS
  A prospective active surveillance study for patients undergoing urologic and cardiothoracic surgeries was implemented from July 2009 to December 2010. Patients were inspected daily for developing SSIs and with a 30-day postoperative follow-up. Wound swabs were obtained from patients who had clinical signs suggestive of infection. Swabs were cultured for bacterial identification and tested for antimicrobial sensitivity. Standard Centers for Disease Control and Prevention National Health Safety Network case definitions were used.
  
  
  RESULTS
  SSIs occurred in 187 (17%) of patients with complete follow-up (n = 1,062), of which 106 (57%) occurred in-hospital and 81 (43%) occurred after discharge. Higher SSI rates were observed in cardiothoracic surgeries (23.3%), compared with urologic surgeries (9%) (P < .001). A stepwise logistic model identified an increased risk of SSI for those who underwent cardiothoracic surgeries (odds ratio [OR], 4.7; 95% confidence interval [CI], 2.2-11.1), those aged >45 years (OR, 2.32; 95% CI, 1.35-4.01), increased duration of hospital stay before (OR, 1.03; 95% CI, 1.01-1.05) and after (OR, 1.07; 95% CI, 1.04-1.09) surgery, antibiotics ≤24 hours before surgery (OR, 2.54; 95% CI, 1.63-3.94), and dirty wounds (OR, 4.09; 95% CI, 1.60-10.43).
  
  
  CONCLUSIONS
  Measures to reduce the high rates of SSI need to be instituted through a multidisciplinary effort including infection control education and specific SSI prevention activities at Alexandria University Hospital.
authors.affiliation: Alexandria University Hospital, Alexandria, Egypt.
authors.forename: Soad
authors.initials: S
authors.lastname: Hafez
authors.forename: Tamer
authors.initials: T
authors.lastname: Saied
authors.forename: Elham
authors.initials: E
authors.lastname: Hasan
authors.forename: Manal
authors.initials: M
authors.lastname: Elnawasany
authors.forename: Eman
authors.initials: E
authors.lastname: Ahmad
authors.forename: Laurel
authors.initials: L
authors.lastname: Lloyd
authors.forename: Waleed
authors.initials: W
authors.lastname: El-Shobary
authors.forename: Brent
authors.initials: B
authors.lastname: House
authors.forename: Maha
authors.initials: M
authors.lastname: Talaat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology; D013520:Urologic Surgical Procedures / Q000009:adverse effects; D055815:Young Adult