Impact of participation in a surgical site infection surveillance network: results from a large international cohort study
Impact of participation in a surgical site infection surveillance network: results from a large international cohort study
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DOI：
10.1016/j.jhin.2018.12.003
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发表时间：
2019-07-01
影响因子：
6.9
通讯作者：
Harbarth, S.
中科院分区：
文献类型：
--
作者：
Abbas, M.;de Kraker, M. E. A.;Harbarth, S.
背景资料：手术部位感染（SSI）监测是有效感染控制实践的核心组成部分，尽管其影响尚未大规模量化。目的：确定监测网络中SSI率的时间趋势。方法：SSI监测网络提供了SSI和手术数量的特定程序数据，按医院参与监测的年份分层，来记录参与的时间长度。合并和程序特定的随机效应泊松回归进行，以获得年率比（RR）与95%的置信区间（CI），并包括监测网络作为随机intercept.Findings：36邀请网络，17个网络从15个高收入国家在亚洲，澳大利亚和欧洲参加了这项研究。收集了17种外科手术（心血管、消化、妇产科、神经外科和骨科）的汇总数据，得到了关于5，831，737例手术和113，166例SSI的数据。总体SSI发生率随监测时间显著下降，在纳入的第9年（最终）监测年降低35%（RR：0.65; 95% CI：0.63-0.67）。有很大的变化在程序的具体趋势，但强烈的一致性下降，观察结直肠手术，疝修补术，剖腹产，髋关节假体，膝关节prosthes.Conclusion：在这个大型的，国际队列研究，合并SSI率与一个稳定的和可持续的下降后，加入SSI监测网络;因果关系是可能的，虽然未经证实。手术特异性趋势存在异质性。这些发现支持了监测在降低感染率方面的关键作用，并呼吁在高收入国家广泛实施以医院为基础的SSI监测。(C)2018年，卫生保健感染协会。由爱思唯尔有限公司出版。保留所有权利。
Background: Surveillance of surgical site infections (SSIs) is a core component of effective infection control practices, though its impact has not been quantified on a large scale.Aim: To determine the time-trend of SSI rates in surveillance networks.Methods: SSI surveillance networks provided procedure-specific data on numbers of SSIs and operations, stratified by hospitals' year of participation in the surveillance, to capture length of participation as an exposure. Pooled and procedure-specific random-effects Poisson regression was performed to obtain yearly rate ratios (RRs) with 95% confidence intervals (CIs), and including surveillance network as random intercept.Findings: Of 36 invited networks, 17 networks from 15 high-income countries across Asia, Australia and Europe participated in the study. Aggregated data on 17 surgical procedures (cardiovascular, digestive, gynaecological-obstetrical, neurosurgical, and orthopaedic) were collected, resulting in data concerning 5,831,737 operations and 113,166 SSIs. There was a significant decrease in overall SSI rates over surveillance time, resulting in a 35% reduction at the ninth (final) included year of surveillance (RR: 0.65; 95% CI: 0.63-0.67). There were large variations across procedure-specific trends, but strong consistent decreases were observed for colorectal surgery, herniorrhaphy, caesarean section, hip prosthesis, and knee prosthesis.Conclusion: In this large, international cohort study, pooled SSI rates were associated with a stable and sustainable decrease after joining an SSI surveillance network; a causal relationship is possible, although unproven. There was heterogeneity in procedure-specific trends. These findings support the pivotal role of surveillance in reducing infection rates and call for widespread implementation of hospital-based SSI surveillance in high-income countries. (C) 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.