title: Risk factors for surgical site infection and association with infliximab administration during surgery for Crohn's disease.
abstract: BACKGROUND
  Preoperative infliximab treatment may influence postoperative infectious complications in patients with Crohn's disease.
  
  
  OBJECTIVE
  The aim of this study was to identify predictors of surgical site infection after surgery for Crohn's disease and evaluate the effects of preoperative infliximab administration.
  
  
  METHODS
  We performed a prospective surveillance and review of surgical site infections.
  
  
  METHODS
  This study was conducted in the Surgical Department of Hyogo College of Medicine.
  
  
  METHODS
  A total of 405 consecutive patients with Crohn's disease who underwent abdominal surgery between January 2008 and December 2011 were included.
  
  
  METHODS
  Infection was diagnosed by the infection control team. The possible risk factors were analyzed by using logistic regression analyses to determine their predictive significance.
  
  
  RESULTS
  Within the patient population, 20% of patients received infliximab, and 60% had penetrating disease. The median duration from the last infliximab infusion to surgery was 43 days (range, 4-80). The overall incidence of surgical site infection was 27%. The incidence of incisional surgical site infection was 18%, and the organ/space surgical site infection rate was 8%. In the multivariate analysis, proctectomy was the highest risk factor for all surgical site infection (OR, 3.4-11.8; p < 0.01). The administration of preoperative infliximab was not a risk factor for surgical site infection. By contrast, there was a significantly reduced risk of incisional surgical site infection in patients with penetrating disease who received infliximab (OR, 0.1; p < 0.01).
  
  
  CONCLUSIONS
  This study was a cohort study and not a randomized trial. The data analyses were performed for surgical site infections but not for other infectious complications.
  
  
  CONCLUSIONS
  Proctectomy was a high-risk factor for surgical site infection in patients with Crohn's disease. The administration of preoperative infliximab was not a risk factor for surgical site infection.
authors.affiliation: 1 Department of Lower Gastroenterological Surgery, Hyogo College of Medicine, Hyogo, Japan 2 Inflammatory Bowel Disease Center, Hyogo College of Medicine, Hyogo, Japan 3 Infection Control and Prevention, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Motoi
authors.initials: M
authors.lastname: Uchino
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ikeuchi
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsuoka
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Bando
authors.forename: Kaoru
authors.initials: K
authors.lastname: Ichiki
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakajima
authors.forename: Naohiro
authors.initials: N
authors.lastname: Tomita
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Takesue
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D003424:Crohn Disease / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010030:Ostomy / Q000009:adverse effects; D057234:Preoperative Period; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors; D012709:Serum Albumin; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000209:etiology*; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D012709:Serum Albumin; D000069285:Infliximab