Surgical site infections after orthopaedic surgery in Cyprus: incidence, risk factors, microbiology and impact

Abstract number: P1458

Kritsotakis E.I., Dimitriadis I., Bagatzouni D., Alexandrou M., Zinieri V., Tsioutis C., Gikas A.

Objectives: To determine the incidence of surgical site infections (SSI) after common orthopaedic surgery procedures in Cyprus, compare observed rates with international data, and specify main epidemiologic features including risk factors, predominant pathogens and resistance patterns, use of antibiotic prophylaxis, and impact of SSI on patient outcome.

Methods: The US National Nosocomial Infections Surveillance (NNIS) system protocols were employed to prospectively collect data for patients who underwent orthopaedic surgery during an 11-month period in the 4 public hospitals of Cyprus. Procedures surveyed included open reduction of fracture (FX), knee prosthesis (KPRO), and hip prosthesis (HPRO). Comparisons of procedure-specific SSI rates with international data were performed by means of standardized infection ratios after stratification by the NNIS risk index. Risk factors for SSI were evaluated by multivariate logistic regression.

Results: A total of 44 SSIs were detected in 1403 operations (3.1 per 100 operations), of which 27% were detected post-discharge. Among the recorded SSI, 61% were superficial, 23% were deep and 16% were organ-space infections. Most frequently isolated pathogens were: Staphylococcus aureus (29.4%; of which 60% methicillin-resistant), Pseudomonas aeruginosa (17.6%; none resistant to ciprofloxacin, ceftazidime or imipenem), Enterococcus spp. (11.8%; none resistant to vancomycin), and coagulase negative staphylococci (11.8%). Antibiotic prophylaxis was administrated for 98% of the procedures classified as clean and for 92% of clean-contaminated procedures, for a median duration of 2 days. Procedure specific SSI rates and risk-adjusted comparisons with international data are presented in the Table. SSI rates were significantly higher for KPRO and HPRO compared with US data, and for KPRO compared with Spanish data. Among 12 potential risk factors examined, significantly and independently associated with increased risk for SSI were: Charlson comorbidity index geqslant R: gt-or-equal, slanted4 (odds ratio [OR]=3.1, p = 0.040), and wound class not clean (OR = 5.6, p < 0.001). The mean postoperative hospital stay was significantly longer for patients with SSI than those without SSI (20.1 vs 10.1 days, p < 0.001). SSI was not associated with mortality.

Conclusion: This study demonstrated the feasibility of implementing a standardized surveillance protocol of SSI in Cypriot public hospitals and generated data useful for designing targeted infection control interventions.

Procedure-specific SSI rates in Cyprus and risk-adjusted comparisons with international data

NNIS Operative Category Study resultsRisk-adjusted comparisons with:
 No. of SSI/SSI rateUS rates [l]Spanish rates [2]UK rates [3]
Knee prosthesis14/2884.94.5<0.0012.50.0021.20.270
Open reduction of fracture24/8322.92.2<0.0010.90.4080.80.240
Hip prosthesis6/2832.11.60.1940.50.0571.10.495
NNIS, National Nosocomial Infection Surveillance system; SSI, surgical site infection, SIR, standardized infection ratio.[1] Am J Infect Control 2004;32:470–85. [2] Am J Infect Control 2006;34:134–41. [3] UK Health Protection Agency 2006.

Session Details

Date: 10/04/2010
Time: 00:00-00:00
Session name: Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases
Location: Vienna, Austria, 10 - 13 April 2010
Presentation type:
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