Predictive factors for early- and late-onset surgical site infections in patients undergoing elective colorectal surgery. A multicentre, prospective, cohort study

• Published in: The Journal of hospital infection Vol. 99; no. 1; pp. 24 - 30
• Main Authors: Gomila, A., Carratalà, J., Biondo, S., Badia, J.M., Fraccalvieri, D., Shaw, E., Diaz-Brito, V., Pagespetit, L., Freixas, N., Brugués, M., Mora, L., Perez, R., Sanz, C., Arroyo, N., Iftimie, S., Limón, E., Gudiol, F., Pujol, M.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.05.2018
• Subjects: Colorectal cancer; Colorectal surgery; Healthcare-associated infection; Surgical site infection; Surgical site infection; Healthcare-associated infection; Colorectal surgery; Colorectal cancer
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1016/j.jhin.2017.12.017

Surgical site infections (SSIs) are the leading cause of healthcare-associated infections in acute care hospitals in Europe. However, the risk factors for the development of early-onset (EO) and late-onset (LO) SSI have not been elucidated. This study investigated the predictive factors for EO-SSI and LO-SSI in a large cohort of patients undergoing colorectal surgery. We prospectively followed-up adult patients undergoing elective colorectal surgery in 10 hospitals (2011–2014). Patients were divided into three groups: EO-SSI, LO-SSI, or no infection (no-SSI). The cut-off defining EO-SSI and LO-SSI was seven days (median time to SSI development). Different predictive factors for EO-SSI and LO-SSI were analysed, comparing each group with the no-SSI patients. Of 3701 patients, 320 (8.6%) and 349 (9.4%) developed EO-SSI and LO-SSI, respectively. The rest had no-SSI. Patients with EO-SSI were mostly males, had colon surgery and developed organ-space SSI whereas LO-SSI patients frequently received chemotherapy or radiotherapy and had incisional SSI. Male sex (odds ratio (OR): 1.92; P < 0.001), American Society of Anesthesiologists' physical status >2 (OR: 1.51; P = 0.01), administration of mechanical bowel preparation (OR: 0.7; P = 0.03) and stoma creation (OR: 1.95; P < 0.001) predicted EO-SSI whereas rectal surgery (OR: 1.43; P = 0.03), prolonged surgery (OR: 1.4; P = 0.03) and previous chemotherapy (OR: 1.8; P = 0.03) predicted LO-SSI. We found distinctive predictive factors for the development of SSI before and after seven days following elective colorectal surgery. These factors could help establish specific preventive measures in each group.