title: Surgical site infections after hysterectomy among HIV-infected women in the HAART era: a single institution's experience from 1999-2012.
abstract: OBJECTIVE
  We sought to determine risk factors associated with surgical site infection (SSI) among a cohort of human immunodeficiency virus (HIV)-infected women undergoing hysterectomy during the era of highly active antiretroviral therapy.
  
  
  METHODS
  This is a retrospective study of HIV-infected women who underwent a hysterectomy for benign indications at a tertiary care center. Electronic medical records were reviewed from January 1999 through December 2012. SSI was defined using Centers for Disease Control and Prevention criteria.
  
  
  RESULTS
  There were 77 HIV-infected women who underwent a hysterectomy: 47 (61%) were abdominal; 16 (21%) were laparoscopic or robot-assisted; and 14 (18%) were vaginal. Acquired immune deficiency syndrome was diagnosed in 58% of patients, and 75% of patients self-reported use of highly active antiretroviral therapy at the time of surgery. There were 17 (22%) SSIs; 5 (29%) superficial incisional wound infections, 3 (18%) vaginal cuff cellulitis, and 9 (53%) pelvic abscesses were diagnosed. After multivariable logistic regression, preoperative albumin level (adjusted odds ratio [aOR], 0.14; 95% confidence interval [CI], 0.02-0.86) and minimally invasive hysterectomy (aOR, 0.16; 95% CI, 0.03-0.84) were associated with decreased SSI. Preoperative absolute CD4 count was not associated with SSI (aOR, 0.99; 95% CI, 0.99-1).
  
  
  CONCLUSIONS
  Low preoperative serum albumin levels and abdominal hysterectomy are associated with increased risk of SSIs in HIV-infected women.
authors.affiliation: Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: colemanj@jhmi.edu.
authors.forename: Jenell Sheree
authors.initials: JS
authors.lastname: Coleman
authors.affiliation: Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Isabel
authors.initials: I
authors.lastname: Green
authors.affiliation: Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Stacey
authors.initials: S
authors.lastname: Scheib
authors.affiliation: Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sewell
authors.affiliation: Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Judy Mon-Hwa
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Jean
authors.initials: J
authors.lastname: Anderson
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis*; D013530:Surgical Wound Infection / Q000209:etiology*
chemical_list: D012709:Serum Albumin
keywords: CD4 count; human immunodeficiency virus; hysterectomy; preoperative albumin; surgical site infection