Poor functional status as a risk factor for surgical site infection due to methicillin-resistant Staphylococcus aureus. Risk factors for methicillin-resistant Staphylococcus aureus surgical site infection. Surgical-site infections at Kilimanjaro Christian Medical Center. Standardized incidence rates of surgical site infection: a multicenter study in Thailand. Risk factors for surgical site infections after pediatric cardiovascular surgery Risk factors for surgical site infections in neurosurgery patients with antibiotic prophylaxis. Risk factors for and effect of a one-year surveillance program on surgical site infection at a university hospital in Turkey. Surgical-site infection rates and risk factor analysis in coronary artery bypass graft surgery. Diminishing surgical site infections in Australia: time trends in infection rates, pathogens and antimicrobial resistance using a comprehensive Victorian surveillance program, 2002-2013. The deadly toll of invasive methicillin-resistant Staphylococcus aureus infection in community hospitals. Risk factors for deep surgical site infections after spinal fusion Six years of surgical wound infection surveillance at a tertiary care center: review of the microbiologic and epidemiological aspects of 20,007 wounds. Does Minimally Invasive Surgery Have a Lower Risk of Surgical Site Infections Compared With Open Spinal Surgery? A Preoperative Decolonization Protocol for Staphylococcus aureus Prevents Orthopaedic Infections Surgical site infections in a tertiary health care center: Prospective cohort study Decolonisation of MRSA and its effect on surgical site infections--a study in a tertiary care institute. Positive nasal culture of methicillin-resistant Staphylococcus aureus (MRSA) is a risk factor for surgical site infection in orthopedics
OBJECTIVE To identify risk factors for  surgical site infection ( SSI ) due to methicillin-resistant Staphylococcus aureus ( MRSA ) . DESIGN Prospect i ve case-control study . SETTING One tertiary and 6 community-based institutions in the southeastern United States . METHODS We compared patients with SSI due to MRSA with 2 control groups : matched uninfected surgical patients and patients with SSI due to methicillin-susceptible S. aureus ( MSSA ) . Multivariable logistic regression was used to determine variables independently associated with SSI due to MRSA , compared with each control group . RESULTS During the 5-year study period , 150 case patients with SSI due to MRSA were identified and compared with 231 matched uninfected control patients and 128 control patients with SSI due to MSSA . Two variables were independently associated with SSI due to MRSA in both multivariable regression models : need for assistance with 3 or more activities of daily living ( odds ratio [ OR ] compared with uninfected patients , 3.97 [ 95 % confidence interval { CI } , 2.18 - 7.25 ] ; OR compared with patients with SSI due to MSSA , 3.88 [ 95 % CI , 1.91 - 7.87 ] ) and prolonged duration of surgery ( OR compared with uninfected patients , 1.98 [ 95 % CI , 1.11 - 3.55 ] ; OR compared with patients with SSI due to MSSA , 2.33 [ 95 % CI , 1.17 - 4.62 ] ) . Lack of independence ( ie , poor functional status ) remained associated with an increased risk of SSI due to MRSA after stratifying by age . CONCLUSIONS Poor functional status was highly associated with SSI due to MRSA in adult surgical patients , regardless of age . A patient 's level of independence can be easily determined , and this information can be used preoperatively to target preventive interventions We prospect ively evaluated 46 possible risk factors for methicillin-resistant Staphylococcus aureus ( MRSA ) surgical site infection ( SSI ) among patients with MRSA carriage in a large intervention study . Of 6,130 study patients , 68 ( 1.1 % ) developed MRSA SSI , which occurred a median of 14 days after surgery . Risk factors associated with MRSA SSI were receipt of emergency surgery , presence of comorbid condition , receipt of immunosuppressive therapy , receipt of contaminated surgery , and a surgical duration longer than the 75th percentile . MRSA carriage on admission did not predict MRSA SSI A five-month prospect i ve survey of  surgical-site infections ( SSI )  was conducted in the department of general surgery at Kilimanjaro Christian Medical Center , Tanzania . SSI were classified according to Centers for Disease Control and Prevention ( CDC ) criteria and identified by bedside surveillance and post-discharge follow-up . This study showed that 77 ( 19.4 % ) of the patients developed SSI  . Twenty-eight ( 36.4 % ) of these infections were apparent only after discharge from hospital . Eighty-seven percent of those who developed SSI had received antibiotic prophylaxis . Significant risk factors for developing SSI during hospital stay were : operations classified as contaminated or dirty , operations lasting for more than 50 min and the length of preoperative stay . The only significant risk factor for those who developed SSI after discharge was having undergone a clean-contaminated operation . Staphylococcus aureus was the most frequently isolated micro-organism followed by Escherichia coli and Klebsiella spp . , most of which were multi-resistant . An exception was S. aureus where 54.5 % of the isolates were fully susceptible . The incidence of SSI and the prevalence of antibiotic resistance in this teaching and tertiary care hospital are high . The risk factors were similar to those reported from countries with more re sources . The findings suggest that infection prevention measures , particularly antibiotic prophylaxis , should be re-evaluated BACKGROUND No previous multicenter data regarding the incidence of  surgical site infection ( SSI ) are available in Thail and . The magnitude of the problem result ing from SSI at the national level could not be assessed . The purpose of this study was to estimate the incidence of SSI in 9 hospitals , together with patterns of surgical antibiotic prophylaxis , risk factors for SSI , and common causative pathogens . METHODS A prospect i ve data collection among patients undergoing surgery in 9 hospitals in Thail and was conducted . The National Nosocomial Infection Surveillance ( NNIS ) system criteria and method were used for identifying and diagnosing SSI . The SSI rates were benchmarked with the NNIS report by means of indirect st and ardization and reported in terms of st and ardized infection ratio ( SIR ) . Antibiotic prophylaxis was categorized into preoperative , intraoperative , and postoperative . Risk factors for SSI were evaluated using multiple logistic regression models . RESULTS From July 1 , 2003 , to February 29 , 2004 , the study included 8764 patients with 8854 major operations and identified 127 SSIs , yielding an SSI rate of 1.4 infections/100 operations and a corresponding SIR of 0.6 ( 95 % CI : 0.5 - 0.8 ) . Of these , 35 SSIs ( 27.6 % ) were detected postdischarge . The 3 most common operative procedures were cesarean section , appendectomy , and hysterectomy . The 3 most common pathogens isolated were Escherichia coli , Staphylococcus aureus , and Pseudomonas aeruginosa , which accounted for 15.3 % , 8.5 % , and 6.8 % of infections , respectively . The 3 most common antibiotics used for prophylaxis were ampicillin/amoxicillin , cefazolin , and gentamicin . The proportion of types of antibiotic prophylaxis administered were 51.6 % preoperative , 24.3 % intraoperative , and 24.1 % postoperative . Factors significantly associated with SSI were high degree of wound contamination , prolonged preoperative hospital stay , emergency operation , and prolonged duration of operation . CONCLUSION Overall SSI rates were less than the average NNIS rates . The causative pathogens of SSI were different from those of other reports . There was a crucial proportion of operations that did not comply with the antibiotic guidelines . The risk factors for SSI identified in this study were consistent with most other reports Background . Although risk factors for surgical site infection ( SSI ) after cardiovascular ( CV ) surgery have been well-documented among adults , few studies have been conducted in children . We performed a case-control study to identify risk factors for hospitalized SSI in children undergoing CV surgery .  Methods . National Nosocomial Infections Surveillance System criteria were used prospect ively to identify cases of hospitalized SSI in patients who underwent CV surgery . Seventy-nine patients who underwent CV surgery without hospitalized SSI were r and omly selected as controls . Cases were compared with controls to determine preoperative , intraoperative and postoperative risk factors for hospitalized SSI . Multivariable logistic regression was performed . Results . An SSI developed in 19 of the 826 patients who underwent CV surgery  ( 2.3 cases per 100 surgeries ) during the study period . Infection was limited to soft tissue in 12 , whereas deeper infection occurred in 7 . Causative agents included Staphylococcus aureus ( 11 ) , coagulase-negative Staphylococcus ( 5 ) and Escherichia coli ( 2 ) . One patient did not have a pathogen isolated . In a multivariable analysis , duration of surgery ( odds ratio , 1.4 ; 95 % confidence interval , 1.2 to 1.8 ) and age < 1 month ( odds ratio , 14 ; 95 % confidence interval , 3.3 to 58.4 ) were independently associated with SSI . Conclusions . Age < 1 month and longer duration of surgery were independently associated with hospitalized SSI after CV surgery in children BACKGROUND This prospect i ve study aim ed to determine the spectrum and the main risk factors of surgical site infection ( SSI )  after neurosurgical procedures in our clinic . METHODS Consecutive patients undergoing neurosurgery between November 1 , 2001 , and November 1 , 2002 , were recruited for the study . All patients were followed for a minimum of 2 weeks postoperatively and all SSIs were recorded . The complete medical records of each case were review ed , and data on 14 possible risk factors were extracted . Statistical analyses were performed to identify the risk factors for SSIs . RESULTS A total of 31 postoperative SSIs were identified among 503 cases included in the study , with a result ing overall infection rate of 6.2 % . The risk of SSI was increased by age ( odds ratio [ OR ] , 1.1 ; 95 % confidence interval [ CI ] , 1.0 - 1.1 ; P = .039 ) , operation type such as " shunt operations " ( OR , 670.4 ; 95 % CI , 2.6 - 171123.1 ; P = .021 ) , presence of foreign body ( OR , 141.0 ; 95 % CI , 2.5 - 7925.9 ; P = .016 ) , presence of diabetes mellitus ( OR , 24.3 ; 95 % CI , 2.1 - 284.9 ; P = .011 ) , and intracranial pressure monitoring ( OR , 4878.9 ; 95 % CI , 23.8 - 1001229 ; P = .002 ) . The predominantly isolated microorganisms in patients with SSIs were Staphylococcus aureus ( 22 [ 71.0 % ] ) , Acinetobacter baumanii ( 5 [ 16.1 % ] ) , and Staphylococcus epidermidis ( 4 [ 12.9 % ] ) . CONCLUSIONS SSIs remain an important problem in neurosurgery . Identification of the risk factors for SSI will help physicians to improve patient care and may decrease mortality , morbidity , and health care costs of neurosurgery patients BACKGROUND Surveillance of surgical site infection ( SSI ) is one of the most effective methods for decreasing the incidence . We determined the risk factors for SSI and the effect of a one-year surveillance program on the rate at a tertiary-care center . METHODS The annual SSI rate before the study period was determined in a preliminary study . Risk factors related to SSI , the bacteria cultured from infected sites , and the effect of surveillance were then analyzed prospect ively . Risk factors were determined by logistic regression analysis , and 95 % confidence intervals were calculated . RESULTS The incidence of SSI decreased from 12.8 % before the study to 8.8 % at the end of the surveillance period . There were 90 SSIs ( 8.8 % ) in 1,017 procedures during the study period , most of which ( 77 ; 69 % ) were detected during the hospital stay . The distribution of superficial incisional , deep incisional , and organ/space SSI was 61.1 % , 33.4 % , and 5.5 % , respectively . Prolonged preoperative hospital stay ( > 8 days ) , abdominal incision , early preoperative hair removal , inappropriate antimicrobial prophylaxis , whole blood transfusion , famotidine treatment , repair with mesh , age > 75 years , wound contamination , high American Society of Anesthesiologists score , malnutrition , diabetes mellitus , emergency surgery , obesity , and coexistent infection proved to be independent risk factors for SSI , whereas the skin closure technique , patient sex , presence of malignancy , smoking history , and duration of operation were not . Staphylococcus aureus and Escherichia coli were the bacteria isolated most frequently . Six infected patients ( 5.4 % ) died , four because of SSI . Development of SSI increased hospital expenses by around 600 US dollars per patient . CONCLUSION Surveillance even for one year decreases the incidence of SSI BACKGROUND The Victorian Infection Control Surveillance Project ( VICSP ) is a multicenter collaborative surveillance project established by infection control practitioners . Five public hospitals contributed data for patients undergoing coronary artery bypass graft ( CABG ) surgery .  OBJECTIVE To determine the aggregate and comparative interhospital surgical-site infection ( SSI ) rates for patients undergoing CABG surgery and the risk factors for SSI in this patient group . METHOD Each institution used st and ardized definitions of SSI , risk adjustment , and reporting methodology according to the National Nosocomial Infections Surveillance System of the Centers for Disease Control and Prevention . Data on potential risk factors were prospect ively collected . RESULTS For 4,474 patients undergoing CABG surgery , the aggregate SSI rate was 7.8 infections per 100 procedures ( 95 % confidence interval [ CI95 ] , 7.0 - 8.5 ) , with individual institutions ranging between 4.5 and 10.7 infections per 100 procedures . Multivariate risk factor analysis demonstrated age ( odds ratio [ OR ] , 1.02 ; CI95 , 1.01 - 1.04 ; P < .001 ) , obesity ( OR , 1.8 ; CI95 , 1.4 - 2.3 ; P < .001 ) , and diabetes mellitus ( OR , 1.6 ; CI95 , 1.2 - 2.1 ; P < .001 ) as independent predictors of SSI . Three hundred thirty-four organisms were isolated from 296 SSIs . Of the total SSIs , methicillin-resistant Staphylococcus aureus was isolated from 32 % , methicillin-sensitive S. aureus from 24 % , gram-negative bacilli ( eg , Enterobacter and Escherichia coli ) from 18 % , and miscellaneous organisms from the remainder . CONCLUSION We documented aggregate and comparative SSI rates among five Victorian public hospitals performing CABG surgery and defined specific independent risk factors for SSI . VICSP data offer opportunities for targeted interventions to reduce SSI following cardiac surgery OBJECTIVE To evaluate time trends in  surgical site infection ( SSI ) rates  and SSI pathogens in Australia . DESIGN Prospect i ve multicenter observational cohort study . SETTING A group of 81 Australian healthcare facilities participating in the Victorian Healthcare Associated Infection Surveillance System ( VICNISS ) . PATIENTS All patients underwent surgeries performed between October 1 , 2002 , and June 30 , 2013 .  National Healthcare Safety Network SSI surveillance methods were employed by the infection prevention staff at the participating hospitals . INTERVENTION Procedure-specific risk-adjusted SSI rates  were calculated . Pathogen-specific and antimicrobial-resistant ( AMR ) infections were modeled using multilevel mixed-effects Poisson regression . RESULTS A total of 183,625 procedures were monitored , and 5,123 SSIs were reported . Each year of observation was associated with 11 % risk reduction for superficial SSI ( risk ratio [ RR ] , 0.89 ; 95 % confidence interval [ CI ] , 0.88 - 0.90 ) , 9 % risk reduction for deep SSI ( RR , 0.91 ; 95 % CI , 0.90 - 0.93 ) , and 5 % risk reduction for organ/space SSI ( RR , 0.95 ; 95 % CI , 0.93 - 0.97 ) . Overall , 3,318 microbiologically confirmed SSIs were reported . Of these SSIs , 1,174 ( 35.4 % ) were associated with orthopedic surgery , 827 ( 24.9 % ) with coronary artery bypass surgery , 490 ( 14.8 % ) with Caesarean sections , and 414 ( 12.5 % ) with colorectal procedures . Staphylococcus aureus was the most frequently identified pathogen , and a statistically significant increase in infections due to ceftriaxone-resistant Escherichia coli was observed ( RR , 1.37 ; 95 % CI , 1.10 - 1.70 ) . CONCLUSIONS St and ardized SSI surveillance methods have been implemented in Victoria , Australia . Over an 11-year period , diminishing rates of SSIs have been observed , although AMR infections increased significantly . Our findings facilitate the refinement of recommended surgical antibiotic prophylaxis regimens and highlight the need for a more expansive national surveillance strategy to identify changes in epidemiology INTRODUCTION Data regarding the epidemiology , treatment , and outcomes of methicillin-resistant Staphylococcus aureus ( MRSA ) infections in rural and community hospitals are limited . METHODS This cohort study was conducted at 1 tertiary care hospital and 8 community hospitals in the southeastern United States . Patients with a surgical site infection ( SSI ) and /or bacteremia due to MRSA were prospect ively identified at each study hospital during the period 1994 - 2003 . RESULTS A total of 129 patients with SSI and 564 patients with bacteremia due to MRSA were identified . Only 57 patients with SSI ( 44.2 % ) received antibiotics active against MRSA on the initial date of diagnosis ; only 95 ( 73.6 % ) received an agent active against MRSA by day 7 after diagnosis of SSI due to MRSA . Ninety-five patients with SSI due to MRSA ( 73.6 % ) were readmitted to the hospital within 90 days after their original surgery . The 1-year mortality rate among patients with SSI due to MRSA was 22 % . Inadequate therapy was also commonly given to patients with bacteremia : only 216 ( 38.3 % ) received antibiotics active against MRSA on the initial day of infection , and only 383 ( 67.9 % ) received an agent active against MRSA by day 7 after diagnosis . Approximately one-third of patients with bloodstream infection died during their initial hospitalization . Patients hospitalized in community hospitals were less likely to receive effective antimicrobial therapy  on both the day of infection and within 7 days after infection , compared with patients in the tertiary care hospital . CONCLUSION Inadequate therapy is commonly administered after diagnosis of SSI and bacteremia due to MRSA in patients in community hospitals Surgical site infections ( SSI ) are undesired and troublesome complications after spinal surgery . The reported infection rates range from 0.7 to 11.9 % , depending on the diagnosis and the complexity of the procedure . Besides operative factors , patient characteristics could also account for increased infection rates . Because the medical , economic and social costs of SSI are enormous , any significant reduction in risks will pay dividends . The purpose of this study is to compare patients who developed deep SSI following lumbar or thoracolumbar spinal fusion with a r and omly selected group of patients who did not develop this complication in order to identify changeable risk factors . With a case – control analysis nested in a historical cohort of patients who had had a spinal fusion between January 1999 and December 2008 , we identified 36 cases with deep SSI ( CDC criteria ) . Information regarding patient-level and surgical-level risk factors was derived from st and ardized but routinely recorded data and compared with those acquired in a r and om selection of 135 uninfected patients . Univariate analyses and a multivariate logistic regression were performed . The overall rate of infection in 1,615 procedures ( 1,568 patients ) was 2.2 % . A positive history of spinal surgery was associated with an almost four times higher infection rate ( OR = 3.7 , 95 % BI = 1.6–8.6 ) . The risk of SSI increased with the number of levels fused , patients with diabetes had an almost six times higher risk and smokers had more than a two times higher risk for deep SSI . The most common organism cultured was Staphylococcus aureus . All infected patients underwent at least one reoperation , including an open débridement and received appropriate antibiotics to treat the organism . Patients who had had a previous spinal surgery are a high-risk group for infection compared with those that never had surgery . Total costs associated with preventive measures are substantial and should be compensated by health care insurance companies by means of separate clinical pathways . High-risk patients should be informed about the increased risk of complications HYPOTHESES ( 1 ) Antibiotic restriction policies result in alteration of microbiologic features of  surgical site infections ( SSIs )  and ( 2 ) reported SSI rates are underestimated when postdischarge surveillance is not included in SSI surveillance efforts . DESIGN Retrospective analysis of prospect ively collected SSI surveillance data . PATIENTS AND METHODS We compared initial microbial isolates from SSIs between ( 1 ) January 1 , 1993 , and December 31 , 1995 , and ( 2 ) January ; 1 , 1996 , and December 31 , 1998 .  Antibiotic restriction policies were implemented at Fairview-University Medical Center , Minneapolis , Minn , on March 1 , 1995 . For the combined periods ( January 1 , 1993 , to December 31 , 1998 ) , we determined  SSI rates for 20007 operations according to the extent of bacterial contamination at surgery ( wound class ) . Then , we analyzed SSI rates for 10559 of these operations ( selected based on availability of Anesthesia Society of America score and type of procedure ) using the surgical wound risk index ( wound class , Anesthesia Society of America score , and length of operation ) . We categorized SSI rates by 17 procedures for comparison with SSI rates  reported by 286 hospitals that contributed data confidentially and voluntarily to the National Nosocomial Infections Surveillance System in 1998 . We compared SSI rates with and without postdischarge surveillance . RESULTS Coagulase-negative staphylococcus and group D enterococcus were the 2 most frequent isolates before and after antibiotic restriction policies were implemented . C and ida albicans isolates decreased from 7.9 % ( 1993 - 1995 ) to 6.5 % ( 1996 - 1998 ; P=.46 ) . Methicillin-resistant Staphylococcus aureus ( 1.8 % of isolates ) and vancomycin-resistant enterococcus ( 2.4 % of isolates ) organisms were first identified between 1996 and 1998 . Our SSI rates were 2.6 % for class I wounds , 3.6 % for class II wounds , and 10.5 % for class III/IV wounds ; 53.9 % of SSIs were identified after hospital discharge . CONCLUSIONS Antibiotic restriction policies did not alter the microbial spectrum of SSIs during the observation period . Reporting SSI rates in the absence of postdischarge surveillance dramatically underestimates actual SSI rates , especially in tertiary care hospitals that provide care for large population s of elderly and immunosuppressed patients Background Surgical site infection ( SSI ) ranges from 1.9 % to 5.5 % in most large series . Minimally invasive surgery ( MIS ) has been postulated to reduce SSI rates . Questions / purpose s(1 ) Is MIS associated with a lower incidence of SSI compared with open spinal surgery ? ( 2 ) Are there other independent risk factors associated with SSI ? ( 3 ) What bacteria are most common in spinal SSI ? Methods Medical records of 2299 patients who underwent transforaminal lumbar interbody fusion , laminectomy , or discectomy  were analyzed and selected for a nested case-control analysis . Twenty-seven cases with SSI were matched with 162 control subjects without SSI stratified based on procedure performed within 28 days of the case ’s date of surgery . Patients were identified from an institutional data base at a tertiary care hospital .  MIS involved spinal procedures performed through a tubular retractor system . Univariate and multivariate analyses were performed . Results Patients undergoing open spinal surgery were 5.77 times more likely to develop SSI compared with MIS approaches ( odds ratio [ OR ] , 5.77 ; 95 % confidence interval [ CI ] , 1.0–32.7 ; p = 0.048 ) . Also , from the multivariate regression model , diabetes ( OR , 4.7 ; 95 % CI , 1.3–17.0 ; p = 0.018 ) , number of levels operated on ( OR , 3.5 ; 95 % CI , 1.6–7.5 ; p = 0.001 ) , and body mass index ( OR , 1.2 ; 95 % CI , 1.0–1.3 ; p = 0.010 ) were predictive of an increased risk in SSI . Staphylococcus aureus was most frequently identified , being present in 12 of 21 ( 52.4 % ) patients in whom positive cultures were obtained . Four of the 12 patients had methicillin-resistant S aureus infection . Conclusions In our series , MIS has a lower incidence of SSI . The risk factors predictive of SSI should be further evaluated in well- design ed prospect i ve trials . Level of Evidence Level III , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence Staphylococcus aureus ( S. aureus ) is an independent risk factor for orthopaedic surgical site infection ( SSI ) . To determine whether a preoperative decolonization protocol reduces S. aureus SSIs , we conducted a prospect i ve observational study of patients undergoing elective total joint arthroplasty ( TJA ) at our institution , with two control groups . The concurrent control group comprised patients of surgeons who did not participate in the intervention study . The preintervention control group comprised patients of participating surgeons who had undergone elective TJA during the year before the study . Patients in the intervention group were screened preoperatively for S. aureus by nasal swab cultures . S. aureus carriers were decolonized with mupirocin ointment to the nares twice daily and chlorhexidine bath once daily for 5 days before surgery . All 164 of 636 participants ( 26 % ) who tested positive completed the decolonization protocol without adverse events and had no postoperative S. aureus SSIs at 1-year followup . In contrast , 1330 concurrent control patients had 12 S. aureus infections . If these infections had occurred in the 26 % of patients expected to be nasal carriers of S. aureus at a given time , the infection rate would have been 3.5 % ( 12 of 345 ) in the control group . In addition , the overall infection rate of the participating surgeons , including nonstaphylococcal infections , decreased from 2.6 % during the preintervention period to 1.5 % during the intervention period , translating to an adjusted economic gain of $ 231,741 for the hospital . The data suggest a preoperative decolonization protocol reduces S. aureus SSIs in patients undergoing TJA.Level of Evidence : Level II , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence Purpose To investigate the incidence and risk factors associated with the development of  surgical site infections ( SSIs ) using the National Nosocomial Infection Surveillance ( NNIS ) . Methods A prospect i ve cohort study was conducted at a tertiary health care center . Infection control personnel collected general and health care related data about patients . The NNIS risk index was calculated on the basis of data relating to the operation : wound contamination class , duration of surgery , and the American Society of Anesthesiologists ( ASA ) score . Results A total of 5109 surgical procedures were included in the study . The overall cumulative incidence rate was 6.3 % . The incidence of SSIs was 2.3 % ( 63.5 % of operative procedures ) , 8.3 % ( 29.7 % ) , 34.6 % ( 6.2 % ) , and 43.3 % ( 0.6 % ) , in patients with 0 , 1 , 2 , and 3 risk index , respectively . The length of hospital stay ( OR : 1.0 ; 95 % CI : 1.053–1.075 ) , preoperative length of stay ( odds ratio [ OR ] : 1.9 ; 95 % confidence interval [ CI ] : 1.953–1.981 ) , antibiotic prophylaxis ( OR : 2.5 ; 95 % CI : 1.421–4.628 ) , drainage ( OR : 1.7 ; 95 % CI : 1.360–2.353 ) , ASA score ( OR : 1.5 ; 95 % CI : 1.235–1.946 ) , class of wound contamination ( OR : 2.0 ; 95 % CI : 1.745–2.003 ) , and NNIS risk index ( OR : 1.3 ; 95 % CI : 1.063–1.7 ) were independently associated with an increased risk for SSIs . Staphylococcus aureus was the most frequently isolated microorganism , 64 % of them being methicillin-resistant . Conclusion The aim of this study was to investigate the most important risk factors associated with the development of surgical site infections ( SSIs ) . Therefore , greater attention has been given to adherence to recommendations for the prevention and control of SSIs as well as to antibiotic prophylaxis protocol BACKGROUND Two-thirds of surgical site infections ( SSI ) because of Staphylococcus aureus are caused by Methicillin resistant Staphylococcus aureus ( MRSA ) . This study was done to assess the efficacy of topical 2 % mupirocin with 2 % chlorhexidine gluconate body wash in decolonizing MRSA and its impact in preventing SSI because of MRSA . The various risk factors associated with MRSA carriers and SSI were also studied because of paucity of data in the developing world . METHODS We did a non-r and omised interventional trial in 602 patients undergoing elective general surgical operations . All patients in case ( 297 ) group were screened for MRSA and those positive were decolonised with topical 2 % mupirocin calcium ointment and daily baths with 2 % chlorhexidine antiseptic solution for 5 days . Control ( 305 ) group patients underwent surgery without decolonisation . Postoperatively , all patients were followed up for SSI for 30 days . RESULTS Prevalence of MRSA carriers was 7.5 % with decolonisation rate of 95.2 % . The SSI incidence was 21.3 % . The significant risk factors for SSI were type of anaesthesia ( p = 0.002 ) , duration of surgery ( p = 0.001 ) and preoperative hospital stay ( p = 0.001 ) . There was a significant association between MRSA carrier positivity at the time of surgery and SSI ( p = 0.041 ) . CONCLUSIONS There was no reduction in rate of SSI or other nosocomial infections in patients undergoing elective general surgical operations following preoperative MRSA decolonisation with 2 % mupirocin and 2 % chlorhexidine gluconate in MRSA carriers . MRSA carrier status was a significant risk factor for SSI but not for other nosocomial infections Background Although nasal carriage of MRSA has been identified as one of the risk factors for surgical site infection ( SSI ) with MRSA , there have been no reports of this in the orthopedics field . Methods This prospect i ve observational cohort study included 2,423 consecutive patients who were admitted to our department over 26 months and who underwent orthopedic surgery .  We examined the relationship between pre-existing nasal MRSA and subsequent occurrence of SSI with MRSA . Results 63 patients ( 2.6 % ) had a positive nasal MRSA culture . 15 patients ( 0.6 % ) developed SSI with MRSA . The occurrence of SSI with MRSA in nasal MRSA carriers was significantly higher than that in non-carriers ( 4 out of 63 ( 6.3 % ) vs. 11 out of 2,360 ( 0.5 % ) ; p < 0.001 ) ( adjusted OR : 11 ; 95 % CI : 3–37 ; p = 0.001 ) . Interpretation We recommend appropriate treatment of patients who are nasal carriers of MRSA before orthopedic surgery
AND RELEVANCE In a broad review of published literature , risk factors for SSI were characterized as describing reduced fitness , patient frailty , surgery duration , and complexity .
IMPORTANCE Surgical site infection ( SSI ) complicates 2 - 5 % of surgeries in the United States .
Severity of SSI ranges from superficial skin infection to life-threatening conditions such as severe sepsis , and SSIs are responsible for increased morbidity , mortality , and economic burden associated with surgery .
Staphylococcus aureus ( S. aureus ) is a commonly-isolated organism for SSI , and methicillin-resistant S. aureus SSI incidence is increasing globally .
OBJECTIVE The objective of this systematic review was to characterize risk factors for SSI within observational studies describing incidence of SSI in a real-world setting .