E Shaw1, A Gomila2, M Piriz3, R Perez4, J Cuquet5, A Vazquez6, J M Badia7, A Lérida8, D Fraccalvieri9, A Marron10, N Freixas11, A Castro12, A Cruz13, E Limón14, F Gudiol14, S Biondo9, J Carratalà15, M Pujol2. 1. Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; Epidemiologia de les infeccions bacterianes, Patologia Infecciosa i Transplantament, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; VINCat Programme, Barcelona, Spain. Electronic address: eshawp@gmail.com. 2. Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; Epidemiologia de les infeccions bacterianes, Patologia Infecciosa i Transplantament, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; VINCat Programme, Barcelona, Spain. 3. VINCat Programme, Barcelona, Spain; Infection Control, Corporació Sanitària Parc Taulí, Barcelona, Spain. 4. VINCat Programme, Barcelona, Spain; Department of Internal Medicine, Fundació Althaia de Manresa, Barcelona, Spain. 5. VINCat Programme, Barcelona, Spain; Department of Internal Medicine, Hospital General de Granollers, Barcelona, Spain. 6. Servei d'Estadística Aplicada, Universitat Autònoma de Barcelona, Barcelona, Spain. 7. VINCat Programme, Barcelona, Spain; Department of General Surgery, Hospital General de Granollers, Barcelona, Spain; Universitat Internacional de Catalunya, Barcelona, Spain. 8. VINCat Programme, Barcelona, Spain; Department of Internal Medicine, Hospital de Viladecans, Barcelona, Spain. 9. VINCat Programme, Barcelona, Spain; Department of General Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain. 10. VINCat Programme, Barcelona, Spain; Department of Internal Medicine, Consorci Sanitari de l'Anoia, Barcelona, Spain. 11. VINCat Programme, Barcelona, Spain; Department of Infectious Diseases, Hospital Universitari Mútua de Terrassa, Barcelona, Spain. 12. VINCat Programme, Barcelona, Spain; Department of Internal Medicine, Hospital Universitari Sant Joan de Reus, Tarragona, Spain. 13. VINCat Programme, Barcelona, Spain; Department of Infectious Diseases, Parc Sanitari Sant Joan de Déu de Sant Boi, Barcelona, Spain. 14. VINCat Programme, Barcelona, Spain; University of Barcelona, Barcelona, Spain. 15. Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; Epidemiologia de les infeccions bacterianes, Patologia Infecciosa i Transplantament, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; VINCat Programme, Barcelona, Spain; University of Barcelona, Barcelona, Spain.
Abstract
BACKGROUND: Accounting for time-dependency and competing events are strongly recommended to estimate excess length of stay (LOS) and risk of death associated with healthcare-associated infections. AIM: To assess the effect of organ/space (OS) surgical site infection (SSI) on excess LOS and in-hospital mortality in patients undergoing elective colorectal surgery (ECS). METHODS: A multicentre prospective adult cohort undergoing ECS, January 2012 to December 2014, at 10 Spanish hospitals was used. SSI was considered the time-varying exposure and defined as incisional (superficial and deep) or OS. Discharge alive and death were the study endpoints. The mean excess LOS was estimated using a multistate model which provided a weighted average based on the states patients passed through. Multivariate Cox regression models were used to assess the effect of OS-SSI on risk of discharge alive or in-hospital mortality. FINDINGS: Of 2778 patients, 343 (12.3%) developed SSI: 194 (7%) OS-SSI and 149 (5.3%) incisional SSI. Compared to incisional SSI or no infection, OS-SSI prolonged LOS by 4.2 days (95% confidence interval (CI): 4.1-4.3) and 9 days (8.9-9.1), respectively, reduced the risk of discharge alive (adjusted hazard ratio (aHR): 0.36 (95% CI: 0.28-0.47) and aHR: 0.17 (0.14-0.21), respectively), and increased the risk of in-hospital mortality (aHR: 8.02 (1.03-62.9) and aHR: 10.7 (3.7-30.9), respectively). CONCLUSION: OS-SSI substantially extended LOS and increased risk of death in patients undergoing ECS. These results reinforce OS-SSI as the SSI with the highest health burden in ECS.
BACKGROUND: Accounting for time-dependency and competing events are strongly recommended to estimate excess length of stay (LOS) and risk of death associated with healthcare-associated infections. AIM: To assess the effect of organ/space (OS) surgical site infection (SSI) on excess LOS and in-hospital mortality in patients undergoing elective colorectal surgery (ECS). METHODS: A multicentre prospective adult cohort undergoing ECS, January 2012 to December 2014, at 10 Spanish hospitals was used. SSI was considered the time-varying exposure and defined as incisional (superficial and deep) or OS. Discharge alive and death were the study endpoints. The mean excess LOS was estimated using a multistate model which provided a weighted average based on the states patients passed through. Multivariate Cox regression models were used to assess the effect of OS-SSI on risk of discharge alive or in-hospital mortality. FINDINGS: Of 2778 patients, 343 (12.3%) developed SSI: 194 (7%) OS-SSI and 149 (5.3%) incisional SSI. Compared to incisional SSI or no infection, OS-SSI prolonged LOS by 4.2 days (95% confidence interval (CI): 4.1-4.3) and 9 days (8.9-9.1), respectively, reduced the risk of discharge alive (adjusted hazard ratio (aHR): 0.36 (95% CI: 0.28-0.47) and aHR: 0.17 (0.14-0.21), respectively), and increased the risk of in-hospital mortality (aHR: 8.02 (1.03-62.9) and aHR: 10.7 (3.7-30.9), respectively). CONCLUSION:OS-SSI substantially extended LOS and increased risk of death in patients undergoing ECS. These results reinforce OS-SSI as the SSI with the highest health burden in ECS.
Authors: Marlon A Guerrero; Brandie Anderson; Gordon Carr; Kara L Snyder; Patrick Boyle; Sharon A Ugwu; Melissa Davis; Susan K Bohnenkamp; Valentine Nfonsam; Taylor S Riall Journal: Patient Saf Surg Date: 2021-04-08
Authors: Tessa Mulder; Marjolein Kluytmans-van den Bergh; Bart Vlaminckx; Daphne Roos; Anne Marie de Smet; Robert de Vos Tot Nederveen Cappel; Paul Verheijen; Alexandra Brandt; Anke Smits; Eric van der Vorm; Erik Bathoorn; Boudewijn van Etten; Jacobien Veenemans; Annemarie Weersink; Margreet Vos; Nils van 't Veer; Stavros Nikolakopoulos; Marc Bonten; Jan Kluytmans Journal: Antimicrob Resist Infect Control Date: 2020-06-15 Impact factor: 4.887
Authors: Janneke D M Verberk; Stephanie M van Rooden; David J Hetem; Herman F Wunderink; Anne L M Vlek; Corianne Meijer; Eva A H van Ravensbergen; Elisabeth G W Huijskens; Saara J Vainio; Marc J M Bonten; Maaike S M van Mourik Journal: Antimicrob Resist Infect Control Date: 2022-01-21 Impact factor: 4.887