title: Surgical site infection after renal transplantation.
abstract: OBJECTIVE
  To identify factors associated with the development of surgical site infection (SSI) among adult patients undergoing renal transplantation
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  An urban tertiary care center in Baltimore, Maryland, with a well-established renal transplantation program that performs ~200-250 renal transplant procedures annually.
  
  
  RESULTS
  At total of 441 adult patients underwent renal transplantation between January 1, 2010, and December 31, 2011. Of these 441 patients, 66 (15%) developed an SSI; of these 66, 31 (47%) were superficial incisional infections and 35 (53%) were deep-incisional or organ-space infections. The average body mass index (BMI) among this patient cohort was 29.7; 84 (42%) were obese (BMI >30). Patients who developed an SSI had a greater mean BMI (31.7 vs 29.4; P=.004) and were more likely to have a history of peripheral vascular disease, rheumatologic disease, and narcotic abuse. History of cerebral vascular disease was protective. Multivariate analysis showed BMI (odds ratio [OR] 1.06; 95% confidence interval [CI], 1.02-1.11) and past history of narcotic use/abuse (OR, 4.86; 95% CI, 1.24-19.12) to be significantly associated with development of SSI after controlling for National Healthcare Surveillance Network (NHSN) score and presence of cerebrovascular, peripheral vascular, and rheumatologic disease.
  
  
  CONCLUSIONS
  We identified higher BMI as a risk factor for the development of SSI following renal transplantation. Notably, neither aggregate comorbidity scores nor NHSN risk index were associated with SSI in this population. Additional risk adjustment measures and research in this area are needed to compare SSIs across transplant centers.
authors.affiliation: 1Department of Epidemiology and Public Health,University of Maryland School of Medicine,Baltimore,Maryland.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harris
authors.affiliation: 2University of Maryland School of Pharmacy,Baltimore,Maryland.
authors.forename: Brandon
authors.initials: B
authors.lastname: Fleming
authors.affiliation: 3Departments of Surgery and Microbiology and Immunology,University of Maryland School of Medicine,Baltimore,Maryland.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Bromberg
authors.affiliation: 4Department of Anesthesiology,University of Maryland School of Medicine,Baltimore,Maryland.
authors.forename: Peter
authors.initials: P
authors.lastname: Rock
authors.affiliation: 5Department of Infection Prevention and Healthcare Epidemiology at the University of Maryland Medical Center,Baltimore,Maryland.
authors.forename: Grace
authors.initials: G
authors.lastname: Nkonge
authors.affiliation: 5Department of Infection Prevention and Healthcare Epidemiology at the University of Maryland Medical Center,Baltimore,Maryland.
authors.forename: Michele
authors.initials: M
authors.lastname: Emerick
authors.affiliation: 5Department of Infection Prevention and Healthcare Epidemiology at the University of Maryland Medical Center,Baltimore,Maryland.
authors.forename: Michelle
authors.initials: M
authors.lastname: Harris-Williams
authors.affiliation: 1Department of Epidemiology and Public Health,University of Maryland School of Medicine,Baltimore,Maryland.
authors.forename: Kerri A
authors.initials: KA
authors.lastname: Thom
mesh_terms: D015992:Body Mass Index; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D009293:Opioid-Related Disorders / Q000150:complications; D016491:Peripheral Vascular Diseases / Q000150:complications; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000150:complications; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*; D062606:Tertiary Care Centers / Q000706:statistics & numerical data