title: May the drain be a way in for microbes in surgical infections?
abstract: BACKGROUND
  Surgical site infection (SSI) is among the most frequent hospital-acquired infections occurring in surgical patients and leads to increased morbidity, mortality, and costs. We aimed to identify risk factors for SSI in patients undergoing surgical procedures, with a particular attention to the use of drains.
  
  
  METHODS
  This study includes all patients undergoing abdominal surgical procedures in 2 surgical wards in a teaching hospital in central Italy. Collected data included patient's demographic and clinical characteristics, procedure characteristics, administration of perioperative antibiotic prophylaxis, and microorganism isolated. The outcome of interest was SSI.
  
  
  RESULTS
  A total of 872 abdominal surgery procedures were surveyed during the study period. Drains were placed in 37.0% of cases. SSI rate was 6.4% globally and 13.6% among the patients with drains, versus 2.4% in those without a drain (P < .001). In 72.1% of cases antibiotic prophylaxis was administered. The logistic regression analysis (P < .001) shown insertion of a drain (odds ratio [OR], 5.14; 95% confidence interval [CI], 2.63-10.08), prolonged surgery (OR, 1.98; 95% CI, 1.09-3.59), and American Society of Anesthesiologists score equal to 3 (OR, 6.13; 95% CI, 2.33-16.11) as independent risk factors for SSI, whereas antibiotic prophylaxis was protective (OR, 0.53; 95% CI, 0.29-0.99).
  
  
  CONCLUSIONS
  This study revealed surgical drains as a risk factor for SSI, pointing out the need of a clearer understanding of drain role in the dynamics of SSI occurrence, with the purpose of decreasing infection risk through targeted preventive interventions.
authors.affiliation: Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy; Hospital Hygiene Service, Ospedali Riuniti di Ancona, Ancona, Italy. Electronic address: p.barbadoro@univpm.it.
authors.forename: Pamela
authors.initials: P
authors.lastname: Barbadoro
authors.affiliation: Department of Experimental and Clinical Medicine, Unit of Surgical Sciences, Università Politecnica delle Marche, Ancona, Italy; General Surgery Ward, Ospedali Riuniti di Ancona, Ancona, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Marmorale
authors.affiliation: Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Recanatini
authors.affiliation: Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Mazzarini
authors.affiliation: Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Pellegrini
authors.affiliation: Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy; Hospital Hygiene Service, Ospedali Riuniti di Ancona, Ancona, Italy.
authors.forename: Marcello M
authors.initials: MM
authors.lastname: D'Errico
authors.affiliation: Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy; Hospital Hygiene Service, Ospedali Riuniti di Ancona, Ancona, Italy.
authors.forename: Emilia
authors.initials: E
authors.lastname: Prospero
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology*
keywords: Risk factor; Surgical site infection; Wound classification