Surgical site infection reporting: more than meets the agar

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• 作者：Luke R. Putnam^a ; ^b ; Tiffany G. Ostovar-Kermani^a ; ^b ; Andrea Le Blanc^b ; ^c ; Kathryn T. Anderson^a ; ^b ; Galit Holzmann-Pazgal^b ; ^c ; Kevin P. Lally^a ; ^b ; KuoJen Tsao^a ; ^b ; ^{kuojen.tsao@uth.tmc.edu}
• 关键词：Appendicitis ; Surgical site infection ; Surveillance ; Organ space infection ; Quality metric
• 刊名：Journal of Pediatric Surgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：52
• 期：1
• 页码：156-160
• 全文大小：474 K
• 卷排序：52

文摘

Surgical site infection (SSI) rate in pediatric appendicitis is a commonly used hospital quality metric. We hypothesized that surveillance of organ-space SSI (OSI) using cultures alone would fail to capture many clinically-important events.MethodsA prospective, multidisciplinary surveillance program recorded 30-day SSI and hospital length of stay (LOS) for patients < 18 years undergoing appendectomy for perforated appendicitis from 2012 to 2015. Standardized treatment pathways were utilized, and OSI was identified by imaging and/or bacterial cultures.ResultsFour hundred ten appendectomies for perforated appendicitis were performed, and a total of 84 OSIs (20.5%) were diagnosed with imaging. Positive cultures were obtained for 39 (46%) OSIs, whereas 45 (54%) had imaging only. Compared to the mean LOS for patients without OSI (5.2 ± 2.9 days), LOS for patients with OSI and positive cultures (13.7 ± 5.4 days) or with OSI without cultures (10.4 ± 3.7 days) was significantly longer (both p < 0.001). The OSI rate identified by positive cultures alone was 9.5%, whereas the clinically-relevant OSI rate was 20.5%.ConclusionsUsing positive cultures alone to capture OSI would have identified less than half of clinically-important infections. Utilizing clinically-relevant SSI is an appropriate metric for comparing hospital quality but requires agreed upon standards for diagnosis and reporting.Level of evidenceII.Type of studyDiagnostic study.