Presencia de infección de sitio quirúrgico en procedimientos gineco-obstétricos en un hospital de II nivel de atención, Honduras 2017-2018 / Presence of surgical site infection in obstetric-gynecological procedures in a level II care hospital, Honduras 2017-2018

OBJETIVO: Identificar la presencia de infección de sitio quirúrgico y factores de riesgo en pacientes sometidas a cirugías Gineco-Obstétricas de forma programada o de urgencia en un hospital de II nivel de atención en Honduras. METODOLOGÍA: Estudio observacional, descriptivo, retrospectivo; recopilando 226 fichas del registro de infección de sitio quirúrgico recuperadas de los expedientes clínicos brindados por el servicio de estadística del Hospital Mario Catarino Rivas. Captando pacientes sometidas a cirugías Gineco-Obstétricas, durante el 2017 y 2018. RESULTADOS: 99 fichas cumplieron los criterios de inclusión, reportando una edad de 24 años [RIQ, 19,0 - 30,0], peso 82,0 kg [RIQ, 51,7 - 98,25], talla 154 cm [150,0 - 158,0] y el IMC de 25,8 ± 3,6 kg/m2. Un 9,1% presento antecedentes de inmunosupresión. 5,1% presento ISQ. El 55.6% de las cirugías se realizó el mismo día de ingreso del paciente. El tiempo entre la profilaxis antibiótica y el comienzo de la intervención quirúrgica es de 60 minutos [RIQ, 40,0 - 160,0]. La duración de los procedimientos quirúrgicos son de 45 minutos [RIQ, 35,0 - 55,0]. Los microrganismos aislados en los cultivos fueron Cocos gram positivos (2/5), Enterococcus faecalis (1/5), Klebsiella pneumoniae (2/5). CONCLUSIÓN: La presencia de ISQ en cirugías Gineco-Obstétricas del HMCR es del 5.1%, identificando los siguientes factores de riesgo: edad extrema, obesidad, diabetes mellitus, estado inmunitario (VIH), profilaxis antibiótica (temprana); por último, la técnica y el tiempo quirúrgico.

OBJECTIVE: To identify the presence of surgical site infection and risk factors in patients undergoing Gynecological-Obstetric surgeries on a scheduled or emergency basis in a 2nd level of care hospital in Honduras. METHODOLOGY: Observational, descriptive, retrospective study, compiling 226 data sheets of the surgical site infection record recovered from the clinical records provided by the statistics service of the "Hospital Mario Catarino Rivas". Recruiting patients undergoing Gynecological-Obstetric surgeries, during 2017 and 2018. RESULTS: 99 tabs met the inclusion criteria, reporting an age of 24 [RIQ, 19.0 - 30.0], weight 82.0 kg [RIQ, 51.7 - 98.25], size 154 cm [150.0 - 158.0] and BMI of 25.8 ± 3.6 kg/m2. 9.1% have a history of immunosuppression. 5.1% present ISQ. 55.6% of surgeries were performed on the same day as the patient's admission. The time between antibiotic prophylaxis and the onset of surgery 60 minutes [RIQ, 40.0 - 160.0]. Duration of surgical procedures 45 minutes [RIQ, 35.0 - 55.0]. Isolated micro-morphisms in crops were Cocos gram positives (2/5), Enterococcus faecalis (1/5), Klebsiella pneumoniae (2/5). CONCLUSION: The presence of ISQ in HMCR Gynecological-Obstetric surgeries is 5.1%, identifying the following risk factors: extreme age, obesity, diabetes mellitus, immune status (HIV), early antibiotic prophylaxis; finally, technique and surgical time.

Morbidade e mortalidade no fechamento de estomas: revisão de 10 anos / Morbidity and mortality of stoma closure: a 10-year review

Introdução: O fechamento de estomas, embora rotineiramente performado, ainda não pode ser considerado um procedimento simples. Nós reportamos, desta forma, a morbidade, mortalidade e fatores de riscos associados a este procedimento em um período de dez anos. Métodos: Revisão retrospectiva de 252 prontuários (149 homens; 103 mulheres), com uma média de 56 anos de idade (18 a 89 anos), que foram submetidos a fechamento de estomas, com análise de complicações clínicas e cirúrgicas, características relacionadas ao estoma, entre outros. Admissão em UTI, complicações precoces (até 30 dias) (classificação de Clavien-Dindo), e tardias, além de óbito, foram analisados. Os testes T de Student, ANOVA, Qui-Quadrado de Pearson, exato de Fischer e de Mann-Whitney foram utilizados para análise paramétrica e não-paramétrica. Resultados: Tumores colorretais (64%) e diverticulite (10%) foram as principais causas para a confecção do estoma. 112 (44,4%) dos pacientes tiveram pelo menos uma complicação cirúrgica. As complicações precoces foram infecção de ferida operatória (13%), fistula e deiscência anastomótica/intestinal (9%), abscessos de cavidade ou parede abdominais (8,3%); tardiamente houveram 36 casos de hérnia incisional (14,2%) e uma estenose intestinal (0,3%). Comorbidades levaram a 10% maior probabilidade de ter uma ou mais complicações cirúrgicas, e todas as cinco mortes ocorreram nestes pacientes (2%). Estomas de intestino grosso, maior tempo operatório e admissão em UTI estiveram significamente relacionados a aumento da morbidade. Conclusão: Pacientes com comorbidades e estomas de intestino grosso tiveram mais risco de complicações. Cuidados pré e perioperatórios, e melhor seleção de pacientes são importantes na redução da morbimortalidade.(AU)

Introduction: Although routinely performed, stoma closure cannot as yet be considered a simple procedure. We report here the morbidity, mortality and risk factors associated with this procedure over a 10-year period. Methods: The medical records of 252 patients (149 men; 103 women), with a mean age of 56 years (18 to 89 years), who underwent stoma closure were retrospectively reviewed for postoperative clinical and surgical complications, stoma-related features, among others. ICU admission, early surgical complications (within 30 days) according to the Clavien-Dindo classification, late surgical complications, and death were analyzed. Student's t-test, ANOVA, Pearson's chi-square test, Fisher's exact test, and MannWhitney U test were used for parametric and nonparametric data. Results: Colorectal tumors (64%) and diverticulitis (10%) were the main reasons for stoma surgery. Overall, 112 (44.4%) patients had at least one surgical complication. Early complications included surgical wound infection (13%), fistula and anastomotic/ intestinal dehiscence (9%), and abdominal wall or intra-abdominal abscesses (8.3%). Late complications included 36 (14.2%) cases of incisional hernia and one case (0.3%) of stricture. Patients with comorbidities were 10% more likely to have one or more surgical complications, and all 5 deaths occurred in these patients (2%). Large-bowel ostomies, longer operative time and ICU admission were significantly related to increased morbidity. Conclusion: Patients with an increased number of comorbidities and large-bowel ostomies are at higher risk for complications. Pre- and perioperative care and accurate patient selection are important to reduce morbidity and mortality.(AU)

Endophthalmitis after cataract surgery: results from seven years of epidemiological surveillance / Endoftalmites após cirurgia de catarata: resultado de sete anos de vigilância epidemiológica

Abstract Purpose: This study aims to describe the incidence, clinical presentation, and evolution of endophthalmitis cases occurred at an ophthalmologic center in Brazil. Methods: This is a review of medical records of patients undergoing cataract surgery from 2008 to 2014. Clinical variables associated with the outcome of postoperative endophthalmitis were evaluated. Results: during the study period, 27,609 cataract surgeries were performed. It was identified 35 cases of endophthalmitis. The overall incidence of endophthalmitis was 0.13%, with an annual variation from 0.04% to 0.27%. The main signs and symptoms in patients with endophthalmitis were ocular pain and low visual acuity associated with conjunctival hyperemia and hypopyon. Gram-positive microorganisms were the most frequent etiological agents. All patients received an intra-vitreous injection of antibiotics as immediate treatment. The final visual acuity was equal to or worse than the ability to count the examiner's fingers in 57.1% of the patients. Evisceration or enucleation was required in 3 patients. Conclusion: The incidence of endophthalmitis and the majority of signs and symptoms found in this study were in agreement with literature in the field. Although the incidence rate is low, the loss of vision experienced by most patients with endophthalmitis after cataract surgery highlights the need for efforts to prevent infection and early diagnosis to avoid such complications.

Resumo Objetivo: Descrever a incidência, a apresentação clínica e a evolução dos casos de endoftalmites ocorridos em um centro oftalmológico no Brasil. Métodos: Trata-se de uma revisão de prontuários dos pacientes submetidos à cirurgia de catarata no período de 2008 a 2014. Foram avaliadas as variáveis clínicas associadas ao desfecho de endoftalmite pós-operatória. Resultados: durante o período do estudo, foram realizadas 27.609 cirurgias de catarata. Foram identificados 35 casos de endoftalmite. A incidência global de endoftalmite foi de 0,13%, com variação anual de 0,04% a 0,27%. Os principais sinais e sintomas em pacientes com endoftalmite foram dor ocular e baixa acuidade visual associado à hiperemia conjuntival e hipópio. Os microrganismos gram-positivos foram os agentes etiológicos mais frequentes. Todos os pacientes receberam uma injeção intravítreo de antibióticos como tratamento imediato. A acuidade visual final foi igual ou pior que a capacidade de contar os dedos do examinador em 57,1% dos pacientes. Evisceração ou enucleação foi necessário em 3 pacientes. Conclusão: A incidência de endoftalmite e a maioria dos sinais e sintomas encontrados neste estudo estão de acordo com os reportados na literatura. Embora a taxa de incidência seja baixa, a perda de visão experimentada pela maioria dos pacientes com endoftalmite após a cirurgia de catarata destaca a necessidade de esforços para medidas de prevenção de infecção e diagnóstico precoce para evitar tais complicações.

Cenário ambulatorial de pacientes com sítio cirúrgico infectado após intervenção cardíaca / Escenario ambulatorial de pacientes con sitio cirugía infectado después intervención cardíaca / Ambulatory setting of patients with surgical site infections after a cardiac intervention

Resumo OBJETIVO Verificar o perfil clínico-cirúrgico e os resultados de pacientes acompanhados em um ambulatório de ferida operatória após cirurgia cardíaca. MÉTODOS Coorte histórica com pacientes submetidos à cirurgia cardíaca e acompanhados por um ano em um ambulatório de feridas de um hospital especializado em cardiologia. Foram analisados os micro-organismos predominantes nas infecções, os produtos utilizados nos curativos, tempo de acompanhamento e o tipo de terapêutica instituída nos curativos. RESULTADOS Entre os 150 pacientes, predominaram sexagenários (61,7 ± 11,4 anos), hipertensos (75%), diabéticos (44,7%). Evidenciou-se 12 pacientes com mediastinite (8%) e 44 com infecção de sítio cirúrgico (29,3%). Utilizou-se para realização dos curativos os ácidos graxos (80%) e alginato de cálcio (19%). O tempo de acompanhamento foi de 35 ±71 dias. CONCLUSÃO Pacientes sexagenários, hipertensos, diabéticos e revascularizados constituíram a população acompanhada no ambulatório de feridas. As taxas de ISC e mediastinite encontradas foram aceitáveis e semelhantes às da literatura.

Resumen OBJETIVO Verificar el perfil clínico-quirúrgico y los resultados de pacientes acompañados en un ambulatorio de heridas operatorias después de cirugía cardiaca. MÉTODO Cohorte histórica con pacientes sometidos a la cirugía cardiaca y acompañados por un año en el ambulatorio de heridas de un hospital especializado en cardiología. Fueron analizados los microorganismos predominantes en las infecciones, los productos utilizados en las curaciones, el tiempo de seguimiento, o el tipo de tratamiento utilizado en las curaciones. RESULTADOS Entre los 150 pacientes predominaron el sexo masculino (58%), sexagenarios (61,7 ± 11,4 años), hipertensos (75%), diabéticos (44.7%). Se evidenciaron 12 pacientes con mediastinitis (8%) y 44 con infección en el sitio quirúrgico (29.3%). Se utilizó en las curaciones fueron los ácidos grasos (80%) y el alginato de calcio (19%). El tiempo medio de seguimiento fue de 35 ± 71 días. CONCLUSIÓN Los pacientes sexagenarios, hipertensos, diabéticos y revascularizados constituyeron la población acompañada en el ambulatorio de heridas. Las tasas de ISC y mediastinitis encontradas fueron aceptables y similares a las de la literatura.

Abstract OBJECTIVE Verifying the clinical-surgical profile and the results of patients monitored in an surgical wound ambulatory after a cardiac surgeries. METHODS This is a historical cohort research with patients submitted to cardiac surgery and monitored for a year in an outpatient surgical wound clinic from a hospital specialized in cardiology. The study analyzed the prevalent microorganisms in infections, the products used in the dressings, the time of follow-up, and the type of therapy established in the dressings. RESULTS Among the 150 patients, most were sexagenarians (61.7 ± 11.4 years), hypertensive patients (75%), and diabetic (44.7%). There were 12 patients with mediastinitis (8%) and 44 with surgical site infection (29.3%). Fatty acids (80%) and calcium alginate (19%) were used for wound healing. The mean follow-up time was 35 ± 71 days. CONCLUSION Sexagenary, hypertensive, diabetic and revascularized patients constituted the population monitored in the wounds outpatient clinic. The SSI and mediastinitis rates found were acceptable and similar to those in literature.

Infecção de sítio cirúrgico após cirurgia bariátrica: resultados de uma abordagem com pacote de cuidados / Surgical site infection in bariatric surgery: results of a care bundle

RESUMO Objetivo: apresentar uma análise descritiva dos resultados de um pacote de cuidados aplicado em pacientes obesos submetidos à cirurgia bariátrica, no que diz respeito ao controle de infecção. Métodos: um pacote de cuidados foi estruturado, visando a conter as taxas de infecção de sítio cirúrgico (ISC) em pacientes submetidos à cirurgia bariátrica. O pacote incluiu interrupção de tabagismo, banho com clorexidina 4% duas horas antes da cirurgia, cefazolina 2g em bolus na indução anestésica associada à administração da mesma droga com dose de 1g em infusão contínua, tricotomia apropriada, controle glicêmico, oxigênio suplementar, normotermia, controle da dor com morfina intrarraquidiana e remoção do curativo estéril 48 horas após a cirurgia. Todos os pacientes foram seguidos por 30 dias. Resultados: entre os 1.596 pacientes incluídos, 334 (20,9%) foram submetidos à cirurgia aberta e 1.262 (79,1%) à cirurgia videolaparoscópica. As taxas de ISC foram de 0,5% no grupo submetido à cirurgia laparoscópica e de 3% nos submetidos à cirurgia aberta. A incidência geral de ISC foi de 1%. Infecções intra-abdominal, do trato respiratório e do trato urinário ocorreram em 0,9%, 1,1% e 1,5% da amostra, respectivamente. Faixas mais elevadas de índice de massa corporal foram associadas a maiores incidências de ISC (p=0,001). Entre os pacientes com diabetes, 2,2% desenvolveram ISC, enquanto a taxa de infecção entre os não diabéticos foi de apenas 0,6%. Conclusão: o pacote de cuidados instituído, estruturado por estratégias centrais baseadas em evidências, associadas à medidas secundárias, foi capaz de manter baixas taxas de ISC após cirurgia bariátrica.

ABSTRACT Objective: to present a descriptive analysis of the results of a care bundle applied to obese patients submitted to bariatric surgery, regarding infection control. Methods: a care bundle was designed to control surgical site infection (SSI) rates in patients undergoing bariatric surgery. The bundle included smoking cessation, bathing with 4% chlorhexidine two hours before surgery, cefazolin (2g bolus) in anesthetic induction associated with a continuous infusion of the same drug at a dose of 1g over a two-hour period, appropriate trichotomy, glycemic control, supplemental oxygen, normothermia, intraspinal morphine for the relief of pain, and sterile dressing removal 48 hours after surgery. All patients were followed up for 30 days. Results: among the 1,596 included patients, 334 (20.9%) underwent open surgery and 1,262 (79.1%) underwent videolaparoscopic surgery. SSI rates were 0.5% in the group submitted to laparoscopic surgery and 3% in the one submitted to open surgery. The overall incidence of SSI was 1%. Intra-abdominal, respiratory tract, and urinary tract infections occurred in 0.9%, 1.1%, and 1.5% of the sample, respectively. Higher body mass index was associated with higher incidence of SSI (p=0.001). Among patients with diabetes, 2.2% developed SSI, while the rate of infection among non-diabetics was only 0.6%. Conclusion: the established care bundle, structured by core evidence-based strategies, associated with secondary measures, was able to maintain low SSI rates after bariatric surgery.

Incidence of surgical site infection after craniotomy: comparison between three months and twelve months of epidemiological surveillance

ABSTRACT Objective: To determine the incidence of surgical site infection in patients undergoing craniotomy and to compare 12-month and 3-month post-discharge surveillance periods in terms of their impact on the incidence of surgical site infection in those patients. Methods: This was a retrospective cohort study involving 173 adult patients submitted to "clean" craniotomy, with or without implants, during the six-month period, at a university hospital in the city of São Paulo, Brazil. All the patients were evaluated in the pre-, trans- and postoperative periods and were followed for 12 months to analyze the development of surgical site infections. Results: Of the 173 patients undergoing craniotomy during the study period, 20 developed an surgical site infection during the first, and 12 months after discharge, the overall incidence of surgical site infection therefore being 11.56%, compared with a 1-month incidence of 8.67% and a 3-month incidence of 10.98%. Among the 106 patients who received implants, the 1-, 3-, and 12-month incidence of surgical site infection was 7.54% (n= 8), 8.49% (n= 9), and 9.43% (n= 10), respectively. Among the 67 patients who did not receive implants, the 1-, 3-, and 12-month incidence of surgical site infection was 10.44% (n= 7), 14.92% (n= 10), and 14.92% (n= 10), respectively. Conclusion: The incidence of surgical site infection after craniotomy is high. Reducing the duration of the post-discharge surveillance period from 12 months to 3 months did not cause significant losses in the numbers of surgical site infection identified or a substantial decrease in their incidence.

Applicability of the surgical site infection risk index to patients undergoing cardiac, neurologic and orthopedic surgery

Introduction: The surgical site infection risk index (SSIRI) includes three risk factors for surgical site infection (SSI): potential for surgical contamination, duration of surgery, and patient's ASA score. A patient having a preoperative American Society of Anesthesiologists (ASA) score of III, IV or IV; a surgery classified as either contaminated or dirty-infected; an operation with duration of surgery more than T hours, where T depends on the surgical procedure being performed are considered in risk of SSI. The SSIRI can be used as a method of postoperative surveillance. The aim of this study is to analyze the applicability of the SSIRI to patients undergoing cardiac, neurologic and orthopedic surgery. Methods: A retrospective cohort study including patients undergoing cardiac, neurological and orthopedic surgeries considered major, from January to December 2014, evaluated through review of medical charts of patients admitted to a university hospital in southern Brazil. Values of p <0.05 were considered significant. Results: A total of 761 patients were included in the study; of these, 122 (16%) developed SSI. The SSIRI did not demonstrate statistical significance to distinguish the patients most likely to develop SSI between the four levels of the ASA score. Black and brown patients, patients who underwent intraoperative blood transfusion, and patients who underwent surgical reintervention were more susceptible to SSI. Conclusions: The SSIRI could not be used as a method of postoperative surveillance for patients in the present study. The other risk factors found may serve as a guide to articulate SSI prevention strategies and, thus, minimize chances of development of serious infections (AU)

Aspectos epidemiológicos das infecções de sítio cirúrgico em cirurgias ortopédicas com implante em um hospital de reabilitação

Este estudo é uma coorte histórica, com informações de 517 pacientes submetidos à cirurgia ortopédica com implante da Rede SARAH Hospitais de Reabilitação, unidade de Brasília, entre os meses de janeiro de 2010 a julho de 2015. Teve como objetivo geral analisar os aspectos epidemiológicos das infecções de sítio cirúrgico em cirurgias ortopédicas com implante. Como objetivos específicos, pretendeu-se estimar a incidência global da infecção, estimar a incidência de infecção por topografia, por tipo de cirurgia, segundo ASA e potencial de contaminação da ferida operatória, identificar possíveis fatores de risco para ocorrência da infecção, identificar os microrganismos responsáveis pela infecção e propor um modelo de predição de risco com as variáveis estudadas. Para alcançar os objetivos propostos, analisaram-se os dados descritivamente através de frequência simples e medidas de tendência central como média mediana e variabilidade desvio-padrão. Em seguida realizou-se modelo de regressão logística GEE para verificar os possíveis fatores de risco associados à infecção de sítio cirúrgico. A população foi caracterizada por pacientes do sexo feminino, com média de idade 58 anos e estar acima do peso corporal (IMC >25kg/m²). Foram diagnosticadas 22 ISC, com incidência global de 3,5% [IC95% 2,1-5,5]. As infecções superficiais foram as mais incidentes (1,4%) e dentre os procedimentos cirúrgicos, as artroplastias de quadril tiveram a taxa mais alta de infecção (4,2%). A incidência de infecção em pacientes classificados com ASA III e IV (6,9%) foi maior do que nos classificados com ASA I e II (2,6%) e a taxa de infecção foi maior em cirurgias classificadas como potencialmente contaminadas e contaminadas (15,6%), enquanto as cirurgias limpas cirurgias limpas a incidência foi de 2,6%. O S. aureus foi o microrganismo mais prevalente. . O modelo de ajustefinal definiu como fatores para infecções cirúrgicas ortopédicas com implante:...

This study is a historical cohort with information from 517 patients submitted to orthopedic surgery with implantation of the SARAH Network of Rehabilitation Hospitals, Brasília unit, from January 2010 to July 2015. Its general objective was to analyze the epidemiological aspects of infections of surgical site in orthopedic surgeries with implant. As a specific objective, it was intended to estimate the global incidence of infection, to estimate the incidence of infection by topography, by type of surgery, according to ASA and potential for wound infection, to identify possible risk factors for infection, to identify microorganisms Responsible for the infection and to propose a model of risk prediction with the studied variables. To reach the proposed objectives, data were analyzed descriptively through simple frequency and measures of central tendency as median mean and standard deviation variability. A GEE logistic regression model was then performed to verify the possible risk factors associated with surgical site infection. The population was characterized by female patients, with a mean age of 58 years and being overweight (BMI> 25kg / m²). Twenty-two ISCs were diagnosed, with a global incidence of 3.5% [95% CI 2.1-5.5]. The superficial infections were the most incidental (1.4%) and among the surgical procedures, hip arthroplasties had the highest rate of infection (4.2%). The incidence of infection in patients classified as ASA III and IV (6.9%) was higher than those classified as ASA I and II (2.6%) and the incidence of infection in clean surgeries was 2.6%. That in potentially contaminated and contaminated surgeries was 15.6%. S. aureus was the most prevalent microorganism. The final adjustment model defined as factors for implant orthopedic surgical infections:...

Incidence and risk factors for surgical site infection in general surgeries / Incidência e fatores de risco para infecção de sítio cirúrgico em cirurgias gerais / Incidencia y factores de riesgo para infección de sitio quirúrgico en cirugías generales

ABSTRACT Objective: to estimate the incidence of surgical site infection in general surgeries at a large Brazilian hospital while identifying risk factors and prevalent microorganisms. Method: non-concurrent cohort study with 16,882 information of patients undergoing general surgery from 2008 to 2011. Data were analyzed by descriptive, bivariate and multivariate analysis. Results: the incidence of surgical site infection was 3.4%. The risk factors associated with surgical site infection were: length of preoperative hospital stay more than 24 hours; duration of surgery in hours; wound class clean-contaminated, contaminated and dirty/infected; and ASA index classified into ASA II, III and IV/V. Staphyloccocus aureus and Escherichia coli were identified. Conclusion: the incidence was lower than that found in the national studies on general surgeries. These risk factors corroborate those presented by the National Nosocomial Infection Surveillance System Risk Index, by the addition of the length of preoperative hospital stay. The identification of the actual incidence of surgical site infection in general surgeries and associated risk factors may support the actions of the health team in order to minimize the complications caused by surgical site infection.

RESUMO Objetivo: estimar a incidência de infecção de sítio cirúrgico em cirurgias gerais de um hospital brasileiro de grande porte, identificando fatores de risco e microrganismo prevalente. Método: estudo de coorte não concorrente com 16.882 informações de pacientes submetidos a cirurgias gerais no período entre 2008 e 2011. Realizada análise descritiva, bivariada e multivariada. Resultado: identificada incidência de infecção de sítio cirúrgico de 3,4%. Os fatores de risco associados à infecção de sítio cirúrgico foram: tempo de internação pré-operatório maior que 24 horas; tempo de duração da cirurgia, em horas; potencial de contaminação da ferida operatória classificado em potencialmente contaminada, contaminada e infectada; e índice ASA classificado em ASA II, III e IV/V. Staphyloccocus aureus e Escherichia coli foram identificados. Conclusão: a incidência apresentou-se menor que estudos nacionais em cirurgias gerais. Os fatores de risco corroboram com aqueles apresentados pelo índice de risco de infecção cirúrgica do National Nosocomial Infection Surveillance System, com a adição do tempo de internação pré-operatória. A identificação da real incidência de infecção de sítio cirúrgico em cirurgias gerais e dos fatores de risco associados podem respaldar ações da equipe de saúde com o intuito de minimizar as complicações causadas pela infecção de sítio cirúrgico.

RESUMEN Objetivo: estimar la incidencia de infección de sitio quirúrgico en cirugías generales de un hospital brasileño de gran porte, identificando los factores de riesgo y los microorganismos prevalentes. Método: estudio de cohorte no concurrente con 16.882 informaciones de pacientes sometidos a cirugías generales en el período entre 2008 y 2011. Se realizó análisis descriptivo bivariado y multivariado. Resultado: se identifico incidencia de infección de sitio quirúrgico de 3,4%. Los factores de riesgo asociados a la infección del sitio quirúrgico fueron: tiempo de internación preoperatorio mayor que 24 horas; tiempo de duración de la cirugía, en horas; potencial de contaminación de la herida de la operación clasificada en potencialmente contaminada, contaminada e infectada; e índice ASA clasificado en ASA II, III y IV/V. Los microorganismos Staphylococcus aureus y Escherichia coli fueron identificados. Conclusión: la incidencia se presentó menor que la encontrada en estudios nacionales en cirugías generales. Los factores de riesgo corroboran los presentados por el índice de riesgo de infección quirúrgica del National Nosocomial Infection Surveillance System, con la adición del tiempo de internación preoperatoria. La identificación de la real incidencia de infección del sitio quirúrgico en cirugías generales y de los factores de riesgo asociados puede respaldar acciones del equipo de salud con el objetivo de minimizar las complicaciones causadas por la infección del sitio quirúrgico.

Surgical site infection and its risk factors in colon surgeries / Infección de sitio quirúrgico y sus factores de riesgo en cirugías de colon / Infecção de sítio cirúrgico e seus fatores de risco em cirurgias de cólon

Abstract OBJECTIVE To identify the occurrence of surgical site infection (SSI) and its risk factors in patients undergoing colon surgery in a tertiary hospital located in the countryside of the state of São Paulo. METHOD Retrospective cohort study, with collection of information contained in the medical records of patients undergoing colon surgery in the period between January 2010 and December 2013. The studied variables were the possible risk factors related to the patient, to demographic characteristics and the surgical procedure. RESULTS In total, were evaluated 155 patients with an overall SSI incidence of 16.7%. A statistically significant association was found both in the univariate as in the multivariate analysis between the SSI and the following variables: male gender, Charlson index and mechanical bowel preparation. CONCLUSION The understanding of health professionals about the factors that influence the incidence of SSI in colon surgery may contribute to the quality of care provided to surgical patients, from effective actions to minimize the risk of infections.

Resumen OBJETIVO Identificar la ocurrencia de infección de sitio quirúrgico (ISQ) y sus factores de riesgo en pacientes sometidos a cirugías de colon, en un hospital terciario del interior del Estado de São Paulo. MÉTODO Estudio de cohorte no concurrente, mediante relevamiento de informaciones contenidas en las fichas de pacientes sometidos a cirugías de colon en el período comprendido entre enero de 2010 y diciembre de 2013. Las variables estudiadas fueron los posibles factores de riesgo vinculados con el paciente, los rasgos demográficos y el procedimiento quirúrgico. RESULTADOS Fueron evaluados 155 pacientes, con una incidencia global de ISQ del 16,7%. Se encontró asociación estadísticamente significativa tanto en el análisis univariado como en el multivariado entre la ISQ y las siguientes variables: sexo masculino, puntuación de Charlson y preparación mecánica intestinal. CONCLUSIÓN La comprensión de los profesionales de la salud acerca de los factores que influencian la incidencia de ISQ en las cirugías de colon puede contribuir a la calidad de la asistencia prestada al paciente quirúrgico mediante acciones efectivas que minimicen los riesgos de infecciones.

Resumo OBJETIVO Identificar a ocorrência de infecção de sítio cirúrgico (ISC) e seus fatores de risco em pacientes submetidos a cirurgias de cólon, em um hospital terciário do interior paulista. MÉTODO Estudo de coorte não concorrente, por meio do levantamento de informações contidas nos prontuários de pacientes submetidos a cirurgias de cólon no período compreendido entre janeiro de 2010 e dezembro de 2013. As variáveis estudadas foram os possíveis fatores de risco ligados ao paciente, às características demográficas e ao procedimento cirúrgico. RESULTADOS Foram avaliados 155 pacientes, com uma incidência global de ISC de 16,7%. Encontrou-se associação estatisticamente significativa tanto na análise uni quanto na multivariada entre a ISC e as seguintes variáveis: sexo masculino, pontuação de Charlson e preparo mecânico intestinal. CONCLUSÃO A compreensão dos profissionais de saúde sobre os fatores que influenciam a incidência de ISC nas cirurgias de cólon pode contribuir para a qualidade da assistência prestada ao paciente cirúrgico a partir de ações efetivas que minimizem os riscos de infecções.

Infecção cirúrgica em pacientes submetidos a cirurgia ortopédica com implante / Surgical infection in patients undergoing orthopedic surgery with implant

Analisar os aspectos epidemiológicos das infecções cirúrgicas nos pacientes submetidos à cirurgia ortopédica com implante. Método: Estudo de corte concorrente de 222 pacientes submetidos a cirurgia ortopédica com implante, realizado entre maio a setembro de 2011, com acompanhamento pós-alta durante um ano por contato telefônico. Na análise estatística, utilizou-se a frequência simples, medidas de tendência central e análise de sobrevivência usando Kaplan Meier e regressão de Cox. Resultados: A população do estudo tinha em média mais de três comorbidades, índice de massa corproral 26Kg/m2 e 62 anos. A taxa de infecção de sítio cirúrgico foi 12,65 e o Staphylococcus aureus o microrganismo mais isolado. Foram fatores de risco para essa infecção: sexo masculino, cirurgia prévia no local operado, não tomar banho pré-operatório, hemotransfusão, doença renal, e não adesão ao protocolo cirúrgico de higienização das mãos pelos profissionais. Conclusão: Essa populaçõ foi caracterizada de alto risco para infecção cirúrgica...

Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study

The present study evaluated patients with diagnosis of surgical site infection (SSI) following cesarean section and their controls to determinate risk factors and impact of antibiotic prophylaxis on this condition. Methods: All cesareans performed from January 2009 to December 2012 were evaluated for SSI, based on criteria established by CDC/NHSN. Control patients were determined after inclusion of case patients. Medical records of case and control patients were reviewed and compared regarding sociodemographic and clinical characteristics. Results: Our study demonstrated an association following univariate analysis between post-cesarean SSI and number of internal vaginal examinations, time of membrane rupture, emergency cesarean and improper use of antibiotic prophylaxis. This same situation did not repeat itself in multivariate analysis with adjustment for risk factors, especially with regard to antibiotic prophylaxis, considering the emergency cesarean factor only. Conclusion: The authors of the present study not only question surgical antimicrobial prophylaxis use based on data presented here and in literature, but suggest that the prophylaxis is perhaps indicated primarily in selected groups of patients undergoing cesarean section. Further research with greater number of patients and evaluated risk factors are fundamental for better understanding of the causes and evolution of surgical site infection after cesarean delivery. .

Predictive factors of post-discharge surgical site infections among patients from a teaching hospital

Introduction Surgical site infections (SSIs) often manifest after patients are discharged and are missed by hospital-based surveillance. Methods We conducted a case-reference study nested in a prospective cohort of patients from six surgical specialties in a teaching hospital. The factors related to SSI were compared for cases identified during the hospital stay and after discharge. Results Among 3,427 patients, 222 (6.4%) acquired an SSI. In 138 of these patients, the onset of the SSI occurred after discharge. Neurological surgery and the use of steroids were independently associated with a greater likelihood of SSI diagnosis during the hospital stay. Conclusions Our results support the idea of a specialty-based strategy for post-discharge SSI surveillance. .

Fatores de risco para infecção de sítio cirúrgico em procedimentos gerais em um hospital público de Belo Horizonte, Minas Gerais - um estudo de incidência / Risk factors for surgical site infection in general procedures in a public hospital of Belo Horizonte, Minas Gerais - an incidence study

Trata-se de uma coorte histórica com informações de 17.707 pacientes submetidos a diversos tipos de procedimentos cirúrgicos em um hospital de ensino de Belo Horizonte, Minas Gerais, nos anos de 2008 a 2011. Este estudo teve como objetivo geral analisar os aspectos epidemiológicos da Infecção de sítio cirúrgico nos pacientes submetidos a procedimentos cirúrgicos gerais. Como objetivos específicos visou-se estimar a incidência global de infecção; estimar a incidência de infecção nos diferentes tipos cirúrgicos estudados; identificar dentre as variáveis coletadas os possíveis fatores de risco predisponentes a infecção de sítio cirúrgico; identificar os microrganismos responsáveis pela infecção; e comparar o poder de predição do Índice de Risco de Infecção Cirúrgica com o modelo construído pelas variáveis do banco estudado. Para alcançar os objetivos propostos, os dados foram analisados de maneira descritiva e posteriormente foi montado um modelo de regressão logística para verificar a associação das variáveis coletadas com a Infecção de Sítio Cirúrgico. Foi encontrada uma incidência de 3,32% [IC 95% = 3,06 – 3,59]. Os procedimentos que obtiveram maior incidência foram as cirurgias de revascularização periférica, 14,52% [IC 95% = 9,79 – 20,41]; a cirurgias no baço 14,29% [IC 95% = 1,77 – 42,81] e cirurgias no ducto biliar 13,86% [IC 95% = 8,99 – 20,06]. Os fatores de risco associados à infecção foram: Tempo de internação pré-operatória maior que 24 horas, tempo operatório maior que 2 horas, classificação do Potencial de Contaminação da Ferida Operatória, American Association of Anesthesiologists e tempo de internação pós-operatória maior que 2 dias. O Staphyloccocus aureus foi a bactéria mais prevalente encontradas nas culturas realizadas (43 das 177 culturas), seguida pela Escherichia coli. Os dados encontrados no estudo similares a estudos semelhantes encontrados na literatura internacional, com exceção do tempo de internação...

This is a historical cohort study from the data of 17.707 patients who underwent any surgical procedure in a teaching hospital in Belo Horizonte, Minas Gerais, between the years of 2008 and 2011. This study had as main objective to analyze the epidemiological aspects of the Surgical Site Infection (SSI) in the patients who underwent general surgical procedures. As secondary objectives it aim to assess the global SSI incidence; to estimate the SSI incidence in different types of surgical procedures; to identify the risk factors for SSI in the collected variables; to identify the main microorganisms responsible for the SSI; and to compare the prediction power of NISS risk index compared with the model built with this study database. To achieve the proposed objectives the data was analyzed descriptively and it was build a logistic regression model to verify the association of the study variables with the SSI. It was found a global incidence of 3,32% [CI 95% = 3,06 – 3,59]. The procedures that had the greatest SSI incidence was Peripheral vascular bypass surgery, 14,52% [CI 95% = 9,79 – 20,41]; Spleen surgery, 14,29% [CI 95% = 1,77 – 42,81]; and gallbladder surgeries, 13,86% [CI 95% = 8,99 – 20,06]. The risk factors related with the SSI in the logistic regression model was preoperative hospital time longer than 24 hours, surgical length, Wound Class, ASA index and postoperative hospital time longer than 2 days. The Staphyloccocus aureus was the most prevalent bacteria isolated from the patients diagnosed with SSI (47 out of 177), being followed by Escherichia coli. The data found in this study is similar to those in international papers, except in this study preoperative hospital time longer than 24 hours and postoperative hospital time longer than 2 days were also a risk factor. Another difference was the SSI incidence rate, it was greater than the incidence found in research's with the American population. This indicates that great...

Inappropriate surgical chemoprophylaxis and surgical site infection rate at a tertiary care teaching hospital

OBJECTIVES: This study aimed to analyze the pattern of surgical chemoprophylaxis, surgical site infection rate, and to check rationality of surgical chemoprophylaxis based on Kunin's criteria. MATERIALS AND METHODS: A prospective, observational study was performed on patients undergoing surgery, in a tertiary care teaching hospital. Data were collected in a pro-forma which included the patients' details, prescriptions from date of admission to discharge or any other outcome and operative notes. Surgical site infection as defined by Centre for Disease Control criteria was recorded. Rationality was assessed based on Kunin's criteria. RESULTS: Total 220 patients were enrolled over a period of one year. Mean hospital stay was 8.67 ± 5.17 days. A total of 2294 drugs were prescribed out of which 840 (36.61%) were antimicrobials. Mean duration for pre-operative intravenous antimicrobial therapy was 0.75 ± 0.45 day and for post-operative intravenous antimicrobial therapy was 3.33 ± 2.24 days while post-operative oral antimicrobial therapy was 4.58 ± 3.34 days. Third generation cephalosporins were prescribed most frequently 64.74% and 64.40% pre-operatively and post-operatively respectively. Antimicrobial prescribing was inappropriate in 52.28%. Total of 19 patients developed surgical site infection. Surgical site infection rate was significantly higher (13.04%) in patients receiving inappropriate chemoprophylaxis (p < 0.01). Surgical site infection adds 9.98 days of hospital stay (p < 0.0001) and 3.57 extra drugs (p < 0.0001) compared to group without surgical site infection. CONCLUSION: Inappropriate use of antimicrobials is highly prevalent in surgical chemoprophylaxis leading to higher surgical site infection rate. Adoption of international standard and formulation of locally feasible guidelines can help overcome this situation.

Infecção de sítio cirúrgico em cirurgias limpas de fraturas de fêmur em um hospital de grande porte de Belo Horizonte: incidência e fatores de risco / Surgical site infection in clean surgery of femur fractures in a large hospital in Belo Horizonte: incidence and risk factors

As infecções decorrentes de cirúrgicas limpas são importantes por sua morbidade, mortalidade e como marcador de qualidade da assistência. O interesse na identificação de fatores de risco para infecções em pacientes cirúrgicos tem aumentado entre profissionais de saúde. Estudos nesse sentido tornam-se cada vez mais necessários, uma vez que as infecções cirúrgicas aumentam o período de hospitalização, os custos da assistência e o sofrimento do paciente. Cirurgias de correção de fraturas de fêmur são frequentes entre os procedimentos cirúrgicos. O objetivo deste trabalho foi estudar os aspectos epidemiológicos da infecção de sítio cirúrgico em pacientes submetidos a cirurgias limpas para correção de fraturas de fêmur. Estudo tipo coorte histórica, identificou os fatores de risco para infecção de sítio cirúrgico (ISC) em pacientes submetidos a cirurgias limpas para correção de fraturas de fêmur em um hospital de grande porte de Belo Horizonte. A coleta dos dados foi feita nos registros dos prontuários eletrônicos no período de julho de 2007a julho de 2009. Foram coletados dados referentes às características dos pacientes, dos procedimentos cirúrgicos e das infecções cirúrgicas. Os fatores de risco para infecção foram identificados por meio de testes estatísticos de hipóteses bilaterais, considerando nível de significância de 5%. As variáveis contínuas foram avaliadas por teste t de student. As variáveis categóricas foram analisadas por meio de teste de qui-quadrado ou exato de Fisher, quando necessário. Para cada fator sob análise, foi obtida uma estimativa pontual e por intervalos de confiança de 95% para o risco relativo. Na última etapa do trabalho, foi realizada uma análise multivariada(regressão logística). Foram incluídos neste estudo 432 pacientes submetidos a cirurgias limpas de correção de fratura de fêmur. A taxa de incidência de ISC foi 4,9% e os fatores de risco identificados foram a presença de acidente vascular cerebral...

Infections resulting from surgical clean is important for its morbidity, mortality, and as a marker of quality of care. The interest in identifying risk factors for infections insurgical patients has increased among health professionals. Studies accordingly become increasingly necessary, since the surgical infections increase the length of hospitalization, cost of care and suffering of the patient. Surgery for correction of femoral fractures are frequent among surgical procedures. The objective of this work was to study the epidemiology of surgical site infection in patients undergoing clean surgery to correct fractures fêmur. Estudo historical cohort, identified the risk factors for surgical site infection (SSI) in patients undergoing surgery clean to fix fractures ofthe femur in a large hospital in Belo Horizonte. Data collection was made in there cords of electronic medical records from July 2007 to July 2009. We collected data on patient characteristics, surgical procedures and surgical infections. Risk factors for infection were identified through statistical hypothesis testing bilateral level of significance of 5%. Continuous variables were evaluated by Student's t test. Categorical variables were analyzed using chi-square or Fisher's exact test when necessary. For each factor under study, we obtained a point estimate and confidence intervals of 95% for the relative risk. In the last stage of this work, we performed a multivariate analysis (logistic regression). The study included 432 patients who underwent correction clean fracture of the femur. The incidence rate of SSI was 4.9%and the risk factors identified were the presence of stroke (odds ratio - OR = 5.0) and hospitalization until surgery over four days (OR = 3,3). We compared the risk of SSIby a surgeon. The prolongation of hospitalization of patients and increased risk of death were complications of ISC found. For this action will be required involving the...

Surgical-site infection risk in oncologic digestive surgery

Surgical-site infection (SSI) is the most prevalent type of hospital infection in surgical patients and is associated with an increase in hospital stay, costs and morbidity/lethality. The knowledge of the main risk factors for this type of infection is important for the establishment of prevention measures regarding modifiable risks factors. The objective of the preset study was to assess the occurrence of SSI and study the risk factors in oncologic surgeries of the digestive system at Hospital de Câncer in Barretos, São Paulo, Brazil. Individuals undergoing oncologic surgeries of the digestive system in the period of 08/01/2007 to 08/10/2008 were prospectively followed for 30 days after surgery. Possible risk factors related to the patient and to the surgical procedure were also studied. A total of 210 surgeries were analyzed, with a global SSI incidence of 23.8 percent. The following variables were independently associated with SSI: time and type of surgery, radiotherapy before surgery and surgeon's years of experience. The risk factors found in this study have been described by other authors and are not amenable to intervention for SSI prevention. Further studies are recommended with the objective of investigating interventions that could reduce the risk for SSI in this type of surgery.

Fatores de risco que afetam as complicações da dissecação da veia safena na revascularização cirúrgica do miocárdio / The risk factors affecting the complications of saphenous vein graft harvesting in aortocoronary bypass surgery

OBJETIVO: O problema da cicatrização de feridas é comumente observado após procedimentos de revascularização do miocárdio. Nosso objetivo é determinar a prevalência e os indicadores de complicação na dissecação da veia safena após procedimentos de revascularização coronária. MÉTODOS: Após revisão e aprovação pelo comitê de ética da instituição, uma revisão retrospectiva de 4029 procedimentos de revascularização foi realizada com enxerto da veia safena durante um período de seis anos. Treze fatores de risco para aqueles que desenvolveram complicações extensas nas feridas da perna foram analisados e comparados com toda a coorte de pacientes submetidos a procedimentos de revascularização semelhantes durante o mesmo período. RESULTADOS: Complicações nas feridas do membro inferior ocorreram em 68 pacientes (1,7 por cento), 43 deles precisaram de intervenção cirúrgica adicional. Foram realizados 17 desbridamentos de feridas, nove transplantes de pele, uma angioplastia, 11 fasciotomias, três procedimentos vasculares e duas transferências livre de tecidos. Das treze variáveis analisadas pela análise multivariada, sexo feminino, IMC, uso de enxerto de veia torácica interna, doença vascular periférica, o uso de balão intra-aórtico no pós-operatório e hiperlipidemia pré-existente foram identificados como indicadores independentes significativos de complicações extensas nas feridas a perna (p<0,05) CONCLUSÕES: As causas das complicações extensas nas feridas da perna após dissecação da veia safena para procedimentos de revascularização miocárdica são multifatoriais. Para minimizar essas complicações, recomendamos avaliações vasculares antes da dissecação da veia safena, atenção com a técnica cirúrgica apropriada e dissecação cuidadosa no local da incisão.

OBJECTIVE: Problem of wound healing is commonly observed after coronary artery bypass graft procedures. Our aim is to determine the prevalence and the predictors of saphenous vein harvesting complication after coronary revascularization procedures. METHODS: After institutional ethical committee review and approval, a retrospective review was undertaken of 4029 bypass procedures with saphenous vein graft performed over a period of six years is conducted. Thirteen risk factors for those who developed major leg wound complications were analyzed and compared with the entire cohort of patients, undergoing similar bypass procedures during the same period. RESULTS: Lower extremity wound complications occurred in 68 patients (1.7 percent), 43 of them required additional surgical interventions. There were 17 wound debridements, nine skin grafts, one angioplasty, 11 fasciotomies, three vascular procedures, and two free tissue transfers. Of 13 variables evaluated by multivariate analysis, female gender, BMI, use of internal thoracic artery graft, peripheral vascular disease, the use of postoperative intraaortic balloon pump and preexisting hyperlipidemia were identified as significant independent predictors of major leg wound complications (p<0.05). CONCLUSIONS: The causes of major leg wound complications after saphenous vein harvest for coronary artery bypass graft procedures are multifactorial. To minimize these complications, we recommend vascular evaluations before saphenous vein harvest, attention to proper surgical technique, and careful harvest site section.

Infección del sitio operatorio en cirugía abdominal no traumática / Surgical site infection in non-traumatic surgery

BACKGROUND: Risk factors of surgical site infection (SSI) have been widely studied, such as abdominal surgery, surgical time >2 h, contaminated or dirty surgery, three or more diagnoses at discharge, and ASA classification >II. METHODS: A prospective risk factor study was carried out for SSI in patients who underwent non-traumatic abdominal surgery, comparing an institutional (Secretary of Health) and a private third-level hospital during the period from October 2001 to May 2002. RESULTS: We studied 527 patients with 21 cases (3.98%) of SSI and four deaths due to this cause, 0.75% of the total population and 19% of patients with SSI. The mean age was 47.5 +/- 19.1 years, and there were 195 (37%) males and 332 (63%) females. The incidence of SSI in the private hospital was 2.1% and in the institutional hospital 5%, without statistical significance (p = 0.09). Within the infected group we found 14 superficial infections, 5 deep infections, and 2 infections in the organ or surgical field. Variables included in the models of logistic regression were smoke, blood transfusion, trichotomy, and wound type. CONCLUSIONS: Observed infection incidence was within the expected range. In our study there were no differences between facilities, and SSI incidence is similar to what has previously been reported.

Resultados de la revascularización miocárdica sin derivación cardiopulmonar en pacientes femeninas / Outcomes of off-pump coronary artery bypass grafting in females

BACKGROUND: Women have more risk factors for coronary bypass graft surgery such as diabetes, high blood pressure, obesity, heart failure and shorter height (less body surface), compared with men. However, off-pump coronary artery bypass grafting demonstrates more benefits in females because of lower mortality, fewer postoperative respiratory complications, shorter hospital stay and improved outcome index. METHODS: We designed a retrospective study from the clinical files of females who underwent off-pump coronary artery bypass graft surgery in our hospital. RESULTS: Significant differences were found between genders in mean age, body surface area, incidence of high blood pressure, unstable angina, left main coronary artery disease or its equivalent, urgent and emergency surgery in relation to preoperative variables. According to the operative variables, we observed significant differences only in incomplete coronary artery bypass grafting. Postoperatively, differences were found in the use of inotropic support, late extubation (>24 h), wound infections and postoperative death. Those differences were evident in the incidence of major and minor adverse outcomes, resulting in major morbidity and mortality in women (p = 0.049). CONCLUSIONS: Higher morbidity and mortality are shown in women than in men after analyzing major and minor adverse outcomes that were more frequent in women.