Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: 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

An analysis of risk factors for arterial hypertension in adolescent students

The objective of the study was to evaluate some risk factors for increases in systemic arterial blood pressure. This transversal study was carried out with 145 individuals from 12 to18 years of age at two state schools in the city of Pico in the state of Piauí in Brazil. The majority were female (62.8%). The median age was 14.8 years (±3.19). It was ascertained that 13 of the subjects (9.0%) were overweight [CI% 73.0-86.0]. Elevations in waist circumference were found in 31 (21.4%) and 76 (52.4%) had elevated arterial blood levels. There was no statistically-significant association between the above-cited risk factors and gender (p=0.088; 0.999; 0.204, respectively). However, 44.8% of the adolescents had at least one risk factor associated with arterial hypertension; 15.9% had two, and 2.1% had three. The study confirms the influence of the risk factors on arterial pressure values among adolescents. Being aware of these factors means that nurses can intervene with health education measures.El objetivo fue evaluar de los algunos factores de riesgo para aumento de los niveles de presión arterial sistémica. Estudio transversal con 145 personas de 12 a 18 años de dos escuelas públicas de la ciudad de Picos-PI. La mayoría eran mujeres (62,8%). La edad media fue de 14,8 años (±3.19). Se encontró 13 (9,0%) tenían exceso de peso [IC% 73,0 a 86,0]. Elevaciones de la circunferencia de cintura se encontraron en 31 (21,4%) y 76 (52,4%) con niveles elevados de presión arterial. No hubo asociación estadísticamente significativa de los factores de riesgo mencionados anteriormente investigado con el sexo (p=0,088, 0,999, 0,204, respectivamente). Sin embargo, 44,8% de los jóvenes tenían al menos un factor; 15,9% dos y 2,1% tres factores relacionados con la hipertensión. Confirma la influencia de factores de riesgo en los valores de presión arterial en la juventud. Delante del conocimiento de estos factores, la enfermería podrá intervenir con medidas de educación en salud.O objetivo do estudo foi avaliar alguns fatores de risco para aumento dos níveis de pressão arterial sistêmica. Trata-se de estudo transversal, desenvolvido com 145 indivíduos de 12 a 18 anos, de duas escolas públicas da cidade de Picos, PI. A maioria era composta por mulheres (62,8%). A média de idade foi de 14,8 anos (±3,19). Verificou-se que 13 (9,0%) apresentavam excesso de peso [IC% 73,0-86,0]. Elevações da circunferência abdominal foram encontradas em 31 (21,4%), e 76 (52,4%) tinham elevação nos níveis de pressão arterial. Não houve associação estatisticamente significante dos fatores de risco investigados citados anteriormente com o sexo (p=0,088; 0,999; 0,204, respectivamente). No entanto, 44,8% dos adolescentes tinham pelo menos um fator, 15,9% dois e 2,1%, três fatores associados indicativos de hipertensão arterial. Confirma-se a influência de fatores de risco sobre os valores da pressão arterial em adolescentes. Diante do conhecimento desses fatores, a enfermagem poderá intervir com medidas de educação em saúde

Multinational prospective cohort study of rates and risk factors for ventilator-associated pneumonia over 24 years in 42 countries of Asia, Africa, Eastern Europe, Latin America, and the Middle East: Findings of the International Nosocomial Infection Control Consortium (INICC)

Objective: Rates of ventilator-associated pneumonia (VAP) in low- and middle-income countries (LMIC) are several times above those of high-income countries. The objective of this study was to identify risk factors (RFs) for VAP cases in ICUs of LMICs. Design: Prospective cohort study. Setting: This study was conducted across 743 ICUs of 282 hospitals in 144 cities in 42 Asian, African, European, Latin American, and Middle Eastern countries. Participants: The study included patients admitted to ICUs across 24 years. Results: In total, 289,643 patients were followed during 1,951,405 patient days and acquired 8,236 VAPs. We analyzed 10 independent variables. Multiple logistic regression identified the following independent VAP RFs: male sex (adjusted odds ratio [aOR], 1.22; 95% confidence interval [CI], 1.16-1.28; P <.0001); longer length of stay (LOS), which increased the risk 7% per day (aOR, 1.07; 95% CI, 1.07-1.08; P <.0001); mechanical ventilation (MV) utilization ratio (aOR, 1.27; 95% CI, 1.23-1.31; P <.0001); continuous positive airway pressure (CPAP), which was associated with the highest risk (aOR, 13.38; 95% CI, 11.57-15.48; P <.0001)Revisión por pare