title: Risk of surgical site infection in older patients in a cohort survey: targets for quality improvement in antibiotic prophylaxis.
abstract: The aims of the present study were to: (1) assess surgical site infection (SSI) incidence in a cohort of surgical patients and (2) estimate the compliance with national guidelines for perioperative antibiotic prophylaxis (PAP). SSIs, among the most common health care-associated infections, are an important target for surveillance and an official priority in several European countries. SSI commonly complicates surgical procedures in older people and is associated with substantial attributable mortality and costs. The implementation of PAP guidelines is difficult among surgeons, and failure to comply with the standard of care has been widely reported. A 12-month prospective survey was performed in accordance with the methods, protocols, and definitions of the Hospital in Europe Link for Infection Control through Surveillance (HELICS) protocol. The compliance of the current PAP practices with the published national guidelines was assessed. A total of 249 patients were enrolled. The cumulative SSI incidence was 3.2 per 100 operative procedures. Cumulative compliance for PAP was 12.4%. Overall, only infection risk index ≥ 1 was confirmed as a significant risk factor for SSI (odds ratio, 6.65; 95% confidence interval, 1.04-42.59; P = 0.045). When only older patients (age >65 years) were considered, no significant risk factors for SSI were identified. Our study indicates an overall inadequate compliance with PAP recommendations, thus highlighting the need to develop multimodal and targeted intervention programs to improve compliance with PAP guidelines.
authors.affiliation: 1 Department G.F. Ingrassia, University of Catania, Catania, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Agodi
authors.forename: Annalisa
authors.initials: A
authors.lastname: Quattrocchi
authors.forename: Martina
authors.initials: M
authors.lastname: Barchitta
authors.forename: Veronica
authors.initials: V
authors.lastname: Adornetto
authors.forename: Aldo
authors.initials: A
authors.lastname: Cocuzza
authors.forename: Rosalia
authors.initials: R
authors.lastname: Latino
authors.forename: Giovanni
authors.initials: G
authors.lastname: Li Destri
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Cataldo
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D058996:Quality Improvement; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Cohort study; Older patients; Surgery; Surgical site infection; Surveillance