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

Data of antihyperlipidaemic activity for methanolic extract of Tagetes patula Linn. flower head along with piperine, as bioavailability enhancer

The data present in this article is associated with influence of piperine (secondary metabolite) on the antihyperlipidemic and antioxidant activity of methanolic extract of Tagetes patula (METP). METP was evaluated for antihyperlipidemic and antioxidant potential. Phytoconstituents of METP were identified using gas chromatography linked with a mass spectrometer. in vivo antihyperlipidemic activity of METP at the dose of 200 and 400 mg/kg b. wt. and 200 and 400 mg/kg b. wt. along with piperine (20 mg/kg b. wt.) were evaluated by Propylthiouracil induced and Triton X-100 induced hyperlipidemia in rats. Propylthiouracil significantly increased the serum TC (p<0.01), TG (p<0.01), LDL (p<0.01) and VLDL (p<0.01) levels and induction of HDL (p<0.01) at a dose of 400 mg/kg b. wt. along with piperine. Triton X-100 at a single dose of i.p increased lipid levels within 48 h. Increased lipid levels were significantly reduced TC (p<0.01), TG (p<0.01), LDL (p<0.05) and VLDL (p<0.05) by METP at doses of 200 and 400 mg/kg b. wt. along with piperine. Current data were also supported by histological study of livers, Cord pattern of hepatocytes, few periportal lymphocytes in focal area observed in hyperlipidemic rats and hepatocyte, periportal and centrilobular region of liver appear normal in treated group. METP along with piperine (capability to enhance bioavailability and has a property of increasing oral absorption of drugs) showed promising antioxidant and antihyperlipidemic activity which suggests the further use of Tagetes patula extract for the management of hyperlipidemia and atherosclerosis. Keywords: Antihyperlipidemic activity, Tagetes patula, Piperine, Triton X-100, Bioavailability, GC–M