Program Schedule

1006
Rates of Complex Surgical Site Infection in a Community Hospital Network Are Declining

Session: Poster Abstract Session: Surgical Site Infections
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC

Rates of Complex Surgical Site Infection in a Community Hospital Network Are Declining

Background:

Surgical site infection (SSI) is a common healthcare-associated infection that causes significant morbidity and mortality.  Only limited published data are available regarding the epidemiology of SSI in community hospitals during the past 5 years.

 

Methods:

We prospectively collected data from complex SSIs (deep-incisional and organ/space infections) in our network of community hospitals from 2008 through 2013.  We determined the overall prevalence rate (PR) of SSI in 2013 and then stratified both by procedure and organism.  Among the 29 hospitals participating in our network over the entire study period, we compared the rates of SSI caused by specific organisms, including S. aureus, each year from 2008 through 2012.  We did not compare SSI rates from 2013 to prior years because of surveillance definition changes.

Results:

In 2013, 753 complex SSIs occurred following 124,358 procedures (PR, 0.61 SSI/100 procedures) performed at 40 hospitals.  Rate of SSI was highest after peripheral vascular bypass (PR, 3.1/100 procedures); abdominal surgery of the bile duct, liver, pancreas, spleen, or small bowel (PR, 2.7/100 procedures); and colon surgery (PR, 2.7/100 procedures).  S. aureus was the most common pathogen, isolated from 221 SSIs (PR, 0.18/100 procedures) in 2013; methicillin-sensitive S. aureus (MSSA) (n=114; PR, 0.09/100 procedures) was slightly more common than methicillin-resistant S. aureus (MRSA) (n=107; PR, 0.09/100 procedures) (Figure 1). 

Overall SSI rates from the 29-hospital cohort decreased from 2008 (PR, 0.76/100 procedures) to 2012 (PR, 0.69/100 procedures; prevalence rate ratio [PRR], 0.90; 95% confidence interval [CI], 0.82-1.00).  The rate of SSI due to S. aureus (PR, 0.27 vs. 0.21/100 procedures; PRR, 0.79; 95% CI, 0.67-0.95) also decreased over this four-year time period.  Rates of SSI from other pathogens were relatively unchanged.

Conclusion:

S. aureus remained the most common cause of SSI in our cohort of community hospitals.  The rate of S. aureus SSI declined due to decreases in both MRSA and MSSA, which paralleled the decline in the overall prevalence of complex SSI.  These data suggest that surgery is becoming safer in community hospitals in our network largely due to decreased rates of SSI due to S. aureus.

 

Arthur W. Baker, MD, Michael J. Durkin, MD, Kristen V. Dicks, MD, Rebekah W. Moehring, MD, MPH, Luke F. Chen, MBBS, MPH, CIC, FRACP, Sarah S. Lewis, MD, Daniel J. Sexton, MD, FIDSA and Deverick Anderson, MD, MPH, Division of Infectious Diseases, Duke University Medical Center, Durham, NC

Disclosures:

A. W. Baker, None

M. J. Durkin, None

K. V. Dicks, None

R. W. Moehring, None

L. F. Chen, None

S. S. Lewis, None

D. J. Sexton, UpToDate: Editor, Royalties
National Football League: Consultant, Consulting fee and Educational grant
Cubist: Grant Investigator, Grant recipient
Johnson and Johnson: Consultant, Consulting fee

D. Anderson, None

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