title: Diminishing surgical site infections in Australia: time trends in infection rates, pathogens and antimicrobial resistance using a comprehensive Victorian surveillance program, 2002-2013.
abstract: OBJECTIVE
  To evaluate time trends in surgical site infection (SSI) rates and SSI pathogens in Australia.
  
  
  METHODS
  Prospective multicenter observational cohort study.
  
  
  METHODS
  A group of 81 Australian healthcare facilities participating in the Victorian Healthcare Associated Infection Surveillance System (VICNISS).
  
  
  METHODS
  All patients underwent surgeries performed between October 1, 2002, and June 30, 2013. National Healthcare Safety Network SSI surveillance methods were employed by the infection prevention staff at the participating hospitals.
  
  
  METHODS
  Procedure-specific risk-adjusted SSI rates were calculated. Pathogen-specific and antimicrobial-resistant (AMR) infections were modeled using multilevel mixed-effects Poisson regression.
  
  
  RESULTS
  A total of 183,625 procedures were monitored, and 5,123 SSIs were reported. Each year of observation was associated with 11% risk reduction for superficial SSI (risk ratio [RR], 0.89; 95% confidence interval [CI], 0.88-0.90), 9% risk reduction for deep SSI (RR, 0.91; 95% CI, 0.90-0.93), and 5% risk reduction for organ/space SSI (RR, 0.95; 95% CI, 0.93-0.97). Overall, 3,318 microbiologically confirmed SSIs were reported. Of these SSIs, 1,174 (35.4%) were associated with orthopedic surgery, 827 (24.9%) with coronary artery bypass surgery, 490 (14.8%) with Caesarean sections, and 414 (12.5%) with colorectal procedures. Staphylococcus aureus was the most frequently identified pathogen, and a statistically significant increase in infections due to ceftriaxone-resistant Escherichia coli was observed (RR, 1.37; 95% CI, 1.10-1.70).
  
  
  CONCLUSIONS
  Standardized SSI surveillance methods have been implemented in Victoria, Australia. Over an 11-year period, diminishing rates of SSIs have been observed, although AMR infections increased significantly. Our findings facilitate the refinement of recommended surgical antibiotic prophylaxis regimens and highlight the need for a more expansive national surveillance strategy to identify changes in epidemiology.
authors.affiliation: Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre,Melbourne,Victoria,3000,Australia.
authors.forename: Leon J
authors.initials: LJ
authors.lastname: Worth
authors.affiliation: Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre,Melbourne,Victoria,3000,Australia.
authors.forename: Ann L
authors.initials: AL
authors.lastname: Bull
authors.affiliation: Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre,Melbourne,Victoria,3000,Australia.
authors.forename: Tim
authors.initials: T
authors.lastname: Spelman
authors.affiliation: Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre,Melbourne,Victoria,3000,Australia.
authors.forename: Judith
authors.initials: J
authors.lastname: Brett
authors.affiliation: Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre,Melbourne,Victoria,3000,Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Richards
mesh_terms: D000328:Adult; D000368:Aged; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D014739:Victoria / Q000453:epidemiology