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Factors Associated With Postoperative Infection

Published online by Cambridge University Press:  02 January 2015

James D. Scott ,
Alan Forrest ,
Steve Feuerstein ,
Paul Fitzpatrick  and
Jerome J. Schentag
James D. Scott*
Affiliation:
Clinical Pharmacokinetics Laboratory, Millard Fillmore Hospital, Buffalo, New York
Alan Forrest
Affiliation:
Clinical Pharmacokinetics Laboratory, Millard Fillmore Hospital, Buffalo, New York
Steve Feuerstein
Affiliation:
Clinical Pharmacokinetics Laboratory, Millard Fillmore Hospital, Buffalo, New York
Paul Fitzpatrick
Affiliation:
Clinical Pharmacokinetics Laboratory, Millard Fillmore Hospital, Buffalo, New York
Jerome J. Schentag
Affiliation:
Clinical Pharmacokinetics Laboratory, Millard Fillmore Hospital, Buffalo, New York
*
Western University of Health Sciences, College of Pharmacy, 309 East 2nd St, Pomona, California 91766-1854
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Abstract

Objective:

We have developed and analyzed a large surgical prophylaxis database and now report the factors significantly associated with early infection, readmission due to infection, and death within 28 days of surgery. This study is intended to be a stepping-stone for further studies using our clinical database.

Design and Setting:

A computerized database of 9,016 surgical patients from a 400-bed community hospital was examined. Multivariate logistic regression and tree-based modeling were used to identify factors associated with the outcomes. Factors considered included surgical procedure, prophylactic antibiotic, age, gender, serum creatinine, and albumin.

Results:

12.6% had an early infection, 2.5% were read-mitted due to infection, and 2.5% died within 28 days. Most combination prophylactic antibiotics were associated with an increased probability of an early infection. Decreased albumin and increased age were associated with an increased probability of an early infection. Tracheostomy and amputations were associated with an increased probability of an early infection, whereas gallbladder and orthopedic procedures involving the arm were associated with a decreased probability. Factors associated with readmission due to infection included dialysis shunt, vascular repair, and an early infection. Factors associated with increased probability of death within 28 days included age, albumin, serum creatinine, and an early infection. Gallbladder procedures and obstetric-gynecologic procedures were associated with a decreased probability of death within 28 days.

Discussion:

Older patients and those with a decreased albumin were most likely to have an early infection. To the extent that an early infection was a significant risk factor for readmission due to infection, the impact of age and albumin on the probability of readmission due to infection is demonstrated by their effects on early infections. Interestingly, albumin and age were significantly associated with death within 28 days, in addition to early infection, showing the predictive association between these factors and early death.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 6 , June 2001 , pp. 347 - 351
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

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References

1.Classen, DC, Evans, RS, Pestotnik, SL, Horn, SD, Menlove, RL, Burke, JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281–286.CrossRefGoogle ScholarPubMed
2.Dellinger, EP, Gross, PA, Barrett, TL, Krause, PJ, Martone, WJ, McGowan, JE Jret al. Quality standard for antimicrobial prophylaxis in surgical procedures. The Infections Diseases Society of America. Infect Control Hosp Epidemiol 1994;15:182–188.CrossRefGoogle ScholarPubMed
3.Antimicrobial prophylaxis in surgery. Med Lett Drugs Ther 1989;31:105–108.Google Scholar
4.Carr, JR, Fitzpatrick, P, Izzo, JL, Cumbo, TJ, Birmingham, MC, Adelman, MH, et al. Changing the infection control paradigm from off-line to real time: The experience at Millard Fillmore Health System. Infect Control Hosp Epidemiol 1997;18:255–259.CrossRefGoogle ScholarPubMed
5.Ariano, RE, Zhanel, GG. Antimicrobial prophylaxis in coronary bypass surgery: a critical appraisal. DICP 1991;25:478–484.Google ScholarPubMed
6.Townsend, TR, Reitz, BA, Bilker, WB, Bartlett, JG. Clinical trial of cefamandole, cefazolin, and cefuroxime for antibiotic prophylaxis in cardiac operations. J Thorac Cardiovasc Surg 1993;106:664–670.CrossRefGoogle ScholarPubMed
7.Nichols, RL, Webb, WR, Jones, JW, Smith, JW, LoCicero, J 3rdEfficacy of antibiotic prophylaxis in high risk gastroduodenal operations. Am J Surg 1982;143:94–98.CrossRefGoogle ScholarPubMed
8.Edwards, WH JrKaiser, AB, Kernodle, DS, Appleby, TC, Edwards, WH SrMartin, RS 3rdet al. Cefuroxime versus cefazolin as prophylaxis in vascular surgery. J Vase Surg 1992;15:35–41.CrossRefGoogle ScholarPubMed
9.Ross, CB, Wheeler, WG 2ndJones, MJ, Kerins, CA, Peek, TE. Ceftriaxone versus cefazolin in peripheral arterial operations: a randomized, prospective trial. South Med J 1997;90:16–22.CrossRefGoogle ScholarPubMed
10.Jewesson, PJ, Stiver, G, Wai, A, Frighetto, L, Nickoloff, D, Smith, J, et al. Double-blind comparison of cefazolin and ceftizoxime for prophylaxis against infections following elective biliary tract surgery. Antimicrob Agents Chemother 1996;40:70–74.CrossRefGoogle ScholarPubMed
11.Hemsell, DL, Johnson, ER, Hemsell, PG, Nobles, BJ, Little, BB, Heard, MC. Cefazolin is inferior to cefotetan as single-dose prophylaxis for women undergoing elective total abdominal hysterectomy. Clin Infect Dis 1995;20:677–684.CrossRefGoogle ScholarPubMed
12.Liebergall, M, Mosheiff, R, Rand, N, Peyser, A, Shaul, J, Kahane, Y, et al. A double-blinded, randomized, controlled clinical trial to compare cefazolin and cefonicid for antimicrobial prophylaxis in clean orthopedic surgery. Isr J Med Sci 1995;31:62–64.Google ScholarPubMed
13.Edwards, WH JrKaiser, AB, Tapper, S, Edwards, WH SrMartin, RS 3rdMulherin, JL Jret al. Cefamandole versus cefazolin in vascular surgical wound infection prophylaxis: cost-effectiveness and risk factors. J Vasc Surg 1993;18:470–475.CrossRefGoogle ScholarPubMed