TY - JOUR
T1 - Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries
T2 - a prospective, international, multicentre cohort study
AU - GlobalSurg Collaborative
AU - Bhangu, Aneel
AU - Ademuyiwa, Adesoji O.
AU - Aguilera, Maria Lorena
AU - Alexander, Philip
AU - Al-Saqqa, Sara W.
AU - Borda-Luque, Giuliano
AU - Costas-Chavarri, Ainhoa
AU - Drake, Thomas M.
AU - Ntirenganya, Faustin
AU - Fitzgerald, J. Edward
AU - Fergusson, Stuart J.
AU - Glasbey, James
AU - Ingabire, JC Allen
AU - Ismaïl, Lawani
AU - Salem, Hosni Khairy
AU - Kojo, Anyomih Theophilus Teddy
AU - Lapitan, Marie Carmela
AU - Lilford, Richard
AU - Mihaljevic, Andre L.
AU - Morton, Dion
AU - Mutabazi, Alphonse Zeta
AU - Nepogodiev, Dmitri
AU - Adisa, Adewale O.
AU - Ots, Riinu
AU - Pata, Francesco
AU - Pinkney, Thomas
AU - Poškus, Tomas
AU - Qureshi, Ahmad Uzair
AU - Ramos-De la Medina, Antonio
AU - Rayne, Sarah
AU - Shaw, Catherine A.
AU - Shu, Sebastian
AU - Spence, Richard
AU - Smart, Neil
AU - Tabiri, Stephen
AU - Harrison, Ewen M.
AU - Khatri, Chetan
AU - Mohan, Midhun
AU - Jaffry, Zahra
AU - Altamini, Afnan
AU - Kirby, Andrew
AU - Søreide, Kjetil
AU - Recinos, Gustavo
AU - Cornick, Jen
AU - Modolo, Maria Marta
AU - Iyer, Dushyant
AU - King, Sebastian
AU - Arthur, Tom
AU - Nahar, Sayeda Nazmum
AU - Koto, Modise Zacharia
N1 - Publisher Copyright:
© 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2018/5
Y1 - 2018/5
N2 - Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. Funding: DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant.
AB - Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. Funding: DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant.
UR - http://www.scopus.com/inward/record.url?scp=85041918898&partnerID=8YFLogxK
U2 - 10.1016/S1473-3099(18)30101-4
DO - 10.1016/S1473-3099(18)30101-4
M3 - Article
C2 - 29452941
AN - SCOPUS:85041918898
SN - 1473-3099
VL - 18
SP - 516
EP - 525
JO - The Lancet Infectious Diseases
JF - The Lancet Infectious Diseases
IS - 5
ER -