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dc.contributor.authorBhangu, Aneel
dc.contributor.authorAdemuyiwa, Adesoji O
dc.contributor.authorAguilera, Maria Lorena
dc.contributor.authorAlexander, Philip
dc.contributor.authorAl-Saqqa, Sara W
dc.contributor.authorBorda-Luque, Giuliano
dc.contributor.authorCostas-Chavarri, Ainhoa
dc.contributor.authorDrake, Thomas M
dc.contributor.authorNtirenganya, Faustin
dc.contributor.authorFitzgerald, J Edward
dc.contributor.authorFergusson, Stuart J
dc.contributor.authorGlasbey, James
dc.contributor.authorIngabire, JC Allen
dc.contributor.authorArthur, Tom
dc.contributor.authoret al.
dc.date.accessioned2020-02-17T06:35:44Z
dc.date.available2020-02-17T06:35:44Z
dc.date.issued2018
dc.identifier.issn1473-3099
dc.identifier.doi10.1016/S1473-3099(18)30101-4
dc.identifier.urihttp://hdl.handle.net/10072/391615
dc.description.abstractBackground: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. Funding: DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant.
dc.description.peerreviewedYes
dc.languageEnglish
dc.language.isoeng
dc.publisherElsevier
dc.relation.ispartofpagefrom516
dc.relation.ispartofpageto525
dc.relation.ispartofissue5
dc.relation.ispartofjournalThe Lancet Infectious Diseases
dc.relation.ispartofvolume18
dc.subject.fieldofresearchClinical sciences
dc.subject.fieldofresearchMedical microbiology
dc.subject.fieldofresearchHealth services and systems
dc.subject.fieldofresearchPublic health
dc.subject.fieldofresearchcode3202
dc.subject.fieldofresearchcode3207
dc.subject.fieldofresearchcode4203
dc.subject.fieldofresearchcode4206
dc.subject.keywordsScience & Technology
dc.subject.keywordsLife Sciences & Biomedicine
dc.subject.keywordsInfectious Diseases
dc.subject.keywordsCARE-ASSOCIATED INFECTION
dc.subject.keywordsHEALTH
dc.titleSurgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationBhangu, A; Ademuyiwa, AO; Aguilera, ML; Alexander, P; Al-Saqqa, SW; Borda-Luque, G; Costas-Chavarri, A; Drake, TM; Ntirenganya, F; Fitzgerald, JE; Fergusson, SJ; Glasbey, J; Ingabire, JCA; Arthur, T; et al., Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study, The Lancet Infectious Diseases, 2018, 18 (5), pp. 516-525
dcterms.dateAccepted2017-12-15
dcterms.licensehttp://creativecommons.org/licenses/by/4.0/
dc.date.updated2020-02-17T06:08:42Z
dc.description.versionVersion of Record (VoR)
gro.rights.copyright© The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
gro.hasfulltextFull Text
gro.griffith.authorArthur, Thomas


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