The burden of Surgical site infection (SSI) after gastrointestinal surgery in countries in all parts of the world was sought to be determined. Researchers noted a disproportionately greater burden of SSI in countries with a low Human Development Index (HDI) than countries with a middle or high HDI. Countries with a low Human Development Index (HDI) thus might have higher rates of antibiotic resistance.

Methods

• Researchers performed an international, prospective, multicentre cohort study including consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country.
• They stratified countries with participating centres into high-income, middle-income, and low-income groups in accordance to the UN's Human Development Index (HDI).
• They entered data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI into risk adjustment models.
• The 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI) was noted to be the primary outcome measure.
• Using Bayesian multilevel logistic regression model, they examined relationships with explanatory variables.  

Results

• For analysis, 13,265 records were submitted between Jan 4, 2016, and July 31, 2016.
• From 343 hospitals in 66 countries, 12,539 patients were included.
• Researchers noted 7,339 (58·5%) patient from high-HDI countries (193 hospitals in 30 countries), 3,918 (31·2%) patients from middle-HDI countries (82 hospitals in 18 countries), and 1,282 (10·2%) patients from low-HDI countries (68 hospitals in 18 countries).
• SSI was noted in 1,538 (12·3%) patients within 30 days of surgery.
• Countries with high (691 [9·4%] of 7,339 patients), middle (549 [14·0%] of 3,918 patients), and low (298 [23·2%] of 1,282) HDI showed variation in the incidence of SSI (p<0·001).
• In each HDI group, the highest SSI incidence was noted 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).
• Patients in low-HDI countries were at greatest risk of SSI following risk factor adjustment (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030).
• In this study, 132 (21·6%) of 610 patients with an SSI and a microbiology culture result showed an infection that was resistant to the prophylactic antibiotic used.
• They identified resistant infections 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).