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Diminishing Surgical Site Infections in Australia: Time Trends in Infection Rates, Pathogens and Antimicrobial Resistance Using a Comprehensive Victorian Surveillance Program, 2002–2013

Published online by Cambridge University Press:  20 January 2015

Leon J. Worth ,
Ann L. Bull ,
Tim Spelman ,
Judith Brett  and
Michael J. Richards
Leon J. Worth*
Affiliation:
Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, Victoria, 3000, Australia
Ann L. Bull
Affiliation:
Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, Victoria, 3000, Australia
Tim Spelman
Affiliation:
Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, Victoria, 3000, Australia
Judith Brett
Affiliation:
Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, Victoria, 3000, Australia
Michael J. Richards
Affiliation:
Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, Victoria, 3000, Australia
*
Address correspondence to Associate Professor Leon J. Worth, Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Doherty Institute, 792 Elizabeth Street, Melbourne, Victoria, 3000, Australia (leon.worth@mh.org.au).
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Abstract

OBJECTIVE

To evaluate time trends in surgical site infection (SSI) rates and SSI pathogens in Australia.

DESIGN

Prospective multicenter observational cohort study.

SETTING

A group of 81 Australian healthcare facilities participating in the Victorian Healthcare Associated Infection Surveillance System (VICNISS).

PATIENTS

All patients underwent surgeries performed between October 1, 2002, and June 30, 2013. National Healthcare Safety Network SSI surveillance methods were employed by the infection prevention staff at the participating hospitals.

INTERVENTION

Procedure-specific risk-adjusted SSI rates were calculated. Pathogen-specific and antimicrobial-resistant (AMR) infections were modeled using multilevel mixed-effects Poisson regression.

RESULTS

A total of 183,625 procedures were monitored, and 5,123 SSIs were reported. Each year of observation was associated with 11% risk reduction for superficial SSI (risk ratio [RR], 0.89; 95% confidence interval [CI], 0.88–0.90), 9% risk reduction for deep SSI (RR, 0.91; 95% CI, 0.90–0.93), and 5% risk reduction for organ/space SSI (RR, 0.95; 95% CI, 0.93–0.97). Overall, 3,318 microbiologically confirmed SSIs were reported. Of these SSIs, 1,174 (35.4%) were associated with orthopedic surgery, 827 (24.9%) with coronary artery bypass surgery, 490 (14.8%) with Caesarean sections, and 414 (12.5%) with colorectal procedures. Staphylococcus aureus was the most frequently identified pathogen, and a statistically significant increase in infections due to ceftriaxone-resistant Escherichia coli was observed (RR, 1.37; 95% CI, 1.10–1.70).

CONCLUSIONS

Standardized SSI surveillance methods have been implemented in Victoria, Australia. Over an 11-year period, diminishing rates of SSIs have been observed, although AMR infections increased significantly. Our findings facilitate the refinement of recommended surgical antibiotic prophylaxis regimens and highlight the need for a more expansive national surveillance strategy to identify changes in epidemiology.

Infect Control Hosp Epidemiol 2015;00(0): 1–8

Information

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 4 , April 2015 , pp. 409 - 416
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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