RESUMEN
In a Policy Forum, Teodora Wi and colleagues discuss the challenges of antimicrobial resistance in gonococci.
Asunto(s)
Antibacterianos/farmacología , Farmacorresistencia Bacteriana , Gonorrea/tratamiento farmacológico , Neisseria gonorrhoeae/efectos de los fármacos , Monitoreo Epidemiológico , Salud Global , HumanosRESUMEN
OBJECTIVE: To assess the risk-adjusted incidence and predictors of surgical site infections (SSIs). DESIGN: Prospective, multicenter, observational cohort study. SETTING: Seven surgical departments at 3 urban academic hospitals in St. Petersburg, Russian Federation. PATIENTS: All patients had surgery performed between January 15 and May 12, 2000. A total of 1,453 surgical procedures were followed up. Medical records were unavailable for less than 3% of all patients; patients were not excluded for any other reason. The mean patient age was 49.3 years, 61% were female, and 34% had an American Society of Anesthesiologists physical status classification (hereafter, "ASA classification") of at least 3. Surgery for 45% of the patients was emergent. RESULTS: In all, 138 patients (9.5%) developed SSI, for a rate that was approximately 3.5 times the risk-stratified rates in the United States. Male sex (odds ratio [OR], 1.54), ASA classifications of 3 (OR, 3.7) or 4 (OR, 5.0), longer duration of surgery (OR, 2.2), and wound classes of 3 (OR, 5.5) or 4 (OR, 14.3) were associated with increased SSI risk in multivariate analysis. Endoscopic surgery was associated with a lower risk of SSI (OR, 0.23). Antibiotic prophylaxis was used in 0%-33% of operations, and 69% of uninfected patients received antibiotics after the operation. CONCLUSIONS: The SSI rates are significantly higher than previously reported. Although this finding may be attributable to inadequate antibiotic prophylaxis, local infection control and surgical practices may also be contributors. Use of antibiotic prophylaxis should be encouraged and the effect of local practices further investigated. Active SSI surveillance should be expanded to other parts of the Russian Federation.