Surgical Site Infections, International Nosocomial

Surgical Site Infections, International Nosocomial Infection Control Consortium (INICC) Report, Data Summary of 30 Countries, for 2005-2010.

Victor D. Rosenthal, MD,1 Rosana Richtmann, MD,2 Sanjeev Singh, MD,3 Nurettin Erben, MD,4 Anucha Apisarnthanarak, MD,5 Erci M. Onzi-Siliprandi, RN,6 Andrzej Kübler, MD, 7 Nguyen Viet-Hung, MD, 8 Ana M. Pérez-Fernandez, MD,9 Fernando M. Ramírez-Wong, MD,10 Silom Jamulitrat, MD,11 Jorge H. Portillo-Gallo, MD,12 María G. Miranda-Novales, MD,13 Alper Sener, MD,14 Cengiz Uzun, MD,15 Eliza Ramirez, RN,16 Jessica Toscani, MD,17 Gunes Senol, MD,18 Gulden Ersoz, MD,19 Murali Chakravarthy, MD,20 Tuna Demirdal, MD,21 Visanu Thamlikitkul, MD,22 Fazilet Duygu, MD,23 Achilleas Gikas, MD,24 Marisol Sánchez, MD,25 Tarquino E. G. Sánchez, MD,26 Sheila Nainan-Myatra, MD,27 Thi Anh Thu Le, MD,28 Teodora Atencio-Espinoza, RN,29 Lourdes Dueñas, MD,30 Amani El-Kholy, MD,31 Sameeh Ghazal, MD,32 Dale Fisher, MD,33 Zan Mitrev, MD,34 Ayse Willke, MD,35 Arpita Dwivedy, MD,36 May Osman Gamar-Elanbya, MD,37, 38 Souha S. Kanj, MD,39 Yolanda Arreza-Galapia, MD,40 Hakan Leblebicioglu, MD,41 Fatma Sirmatel, MD,42 Nefise Oztoprak, MD,43 Yazmín León-Vega, MD,44 Iftihar Koksal, MD, 45 Oral Oncul, MD,46 Yunus Gurbuz, MD,47 Nazan Tuna, MD,48 Soňa Hlinková, MD,49,50 Badaruddin A. Memon, MD,51 Iqbal Bagasrawala, MD,52 Nita Munshi, MD,53 Tanu Singhal, MD,54 Jorge Quintero, MD,55 Humberto Guanche-Garcell, MD,56 Edwin ChapetaParada, MD,57 Sonia Tome, MD,58 Jacobo Ayala-Gaytan, MD,59 Vaidotas Gurskis, MD,60 Martha C. Culebro-Burguete, MD,61 Carlos Álvarez-Moreno, MD,62 Amina Barkat, MD, 63 Socorro L. Torres-Zegarra, MD,64 Nepomuceno Mejía, MD,65 Bishnu Panigrahi, MD,66 Huseyin Turgut, MD,67 Ata Nevzat-Yalcin, MD,68 Magda Rojas-Bonilla, MD,69 Goran Ristic, MD,70 Gabriel Arteaga-Troncoso, MD,71 Victor R. Ortiz-Juárez, MD,72 Lul Raka,

MD,73 Sanjeev Sood, MD,74 Davut Ozdemir, MD,75 Marina Moreira, MD,76 Cheong YuetMeng, MD,77 Pravin Kumar-Nair, MD,78 Josephine A Navoa-Ng, MD,79 David YepesGomez, MD,80 Tanil Kendirli, MD,81 Turan Aslan, MD,82 Tatiana Sánchez, MD,83 Rédouane Abouqal, MD.84

1. International Nosocomial Infection Control Consortium, Buenos Aires, Argentina; 2. Hospital Maternidade Santa Joana, São Paulo, Brazil; 3. Amrita Institute of Medical Sciences & Research Center, Kochi , India; 4. Eskisehir Osmangazi University, Eskisehir , Turkey; 5. Thammasart University Hospital, Pratumthani , Thailand; 6. Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil; 7. University Hospital of Wroclaw, Wroclaw, Poland; 8. Bach Mai Hospital, Hanoi, Vietnam; 9. Clínica Central Del Quindio, Armenia, Colombia; 10. Hospital de Emergencias José Casimiro Ulloa, Lima, Peru; 11. Songklanagarind Hospital, Songkla, Thailand; 12. CIMA, Chihuaha, Mexico; 13. CMN Siglo XXI, Mexico City, Mexico; 14. Onsekiz Mart University Canakkale, Canakkale, Turkey; 15. German Hospital, Istanbul, Turkey; 16. ESSALUD- Red Asistencial ANCASH- Hospital III, Chimbote, Peru; 17. Sanatorio Amedrin, Fray Bentos, Uruguay; 18. Izmir Chest Diseases and Chest Surgery Training Hospital, Izmir, Turkey; 19. Mersin University, Faculty of Medicine, Mersin, Turkey;

20. Fortis Hospital, Bangalore, India; 21. Afyon Kocatepe University Hospital, Afyonkarahisar, Turkey; 22. Siriraj Hospital, Mahidol University, Bangkok, Thailand; 23. Tokat State Hospital, Tokat, Turkey; 24. University Hospital of Heraklion, Heraklion, Greece; 25. Hospital General Norte, Puebla, Mexico; 26. Hospital Anchieta Ltda., Taguatinga, Brazil; 27. Tata Memorial Hospital, Mumbai, India; 28. Cho Ray Hospital, Ho Chi Minh City, Vietnam; 29. Hospital Regional de Pucallpa, Ucayali, Peru; 30. Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador; 31. Dar Al Fouad Hospital, Cairo, Egypt; 32. King Fahad Medical City, Riyadh, Saudia Arabia; 33. National University Hospital, Singapore, Republic of Singapore; 34. Filip II Special Hospital for Surgery, Skopje, Macedonia; 35. Kocaeli University Hospital, Kocaeli, Turkey; 36. Dr L H Hiranandani Hospital, Mumbai, India; 37. Bahry Teaching Hospital, Khartoum, Sudan; 38. Khartoum Dental Teaching Hospital, Khartoum, Sudan; 39. American University of Beirut Medical Center, Beirut, Lebanon; 40. National Kidney and Transplant Institute, Quezon City, Philippines; 41. Ondokuz Mayis University Medical School, Samsun, Turkey; 42. Abant Izzet Baysal University, Medical Faculty, Bolu, Turkey; 43. Antalya Education and Research Hospital, Antalya, Turkey;

44. Clínica del Occidente, Bogota, Colombia; 45. Karadeniz Technical University, Trabzon, Turkey; 46. Gulhane Military Medical Academy, Istanbul, Turkey; 47. SB Dıskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey; 48. Sakarya Universty, Faculty of Medicine, Sakarya, Turkey; 49. Catholic University, Faculty of Medicine, Ružomberok, Slovakia; 50. Military Hospital SNP Ružomberok, Ružomberok, Slovakia; 51. Public Sector Hospital Khairpur, Sindh, Pakistan; 52. Saifee Hospital, Mumbai, India; 53. Ruby Hall Clinic, Pune, India; 54. Kokilaben Dhirubhai Ambani Hospital, Mumbai, India; 55. IPS Universitaria, Medellín, Colombia; 56. Hospital Docente Clínico Quirúrgico "Joaquín Albarrán Domínguez", Havana, Cuba; 57. Hospital San Vicente de Arauca, Arauca, Colombia; 58. Hospital 4 de Junio, Sáenz Peña, Argentina; 59. Hospital San José-Tec de Monterrey, Monterrey, Mexico; 60. Lithuanian University of Health Sciences, Kaunas, Lithuania; 61. Hospital de Especialidades Pediátricas, Chiapas, Mexico; 62. Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogota, Colombia; 63. Children Hôspital of Rabat, Rabat, Morocco; 64. Hospital Nacional Docente Madre Niño San Bartolomé, Lima, Peru; 65. Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic;

66. Max Healthcare, New Delhi, India; 67. Pamukkale University Faculty of Medicine, Denizli, Turkey; 68. Akdeniz University, Antalya, Turkey 69. Hospital de Especialidades Pediátricas "Omar Torrijos Herrera", Panama City, Panama; 70. Mother and Child Health Institute of Serbia, Belgrade, Serbia; 71. Instituto Nacional de Perinatología, Mexico City, Mexico; 72. Hospital Betania, Puebla, México; 73. National Institute for Public Health of Kosovo and Medical School, Prishtina University, Prishtina, Kosovo; 74. Military Hospital, Jodhpur, India; 75. Duzce University Medical School Infectious Diseases and Clinical Microbiology, Duzce, Turkey; 76. Hospital Universitario de Taubaté, Taubaté, Brazil; 77. Sunway Medical Centre Berhad and Monash University Sunway Campus, Petaling Jaya, Malaysia; 78. Holy Spirit Hospital, Mumbai, India; 79. Saint Luke's, Quezon City, Philippines; 80. Clínica CES, Medellín, Colombia; 81. Ankara University School of Medicine, Ankara, Turkey; 82. Bezmialem Vakif University, Istanbul, Turkey; 83. Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic; 84. Ibnsina Hospital, Rabat, Morocco.

*For a list of members of the International Nosocomial Infection Control Consortium, see the Appendix.

Running head: Surgical Site Infections, INICC Report Word count: 2096 References: 23 Tables: 3

ABSTRACT OBJECTIVE: To report the results of a surveillance study on surgical site infections (SSIs) conducted by the International Nosocomial Infection Control Consortium (INICC). DESIGN: Cohort prospective multinational multicenter surveillance study. SETTING: Eighty-two hospitals of 66 cities in 30 countries (Argentina, Brazil, Colombia, Cuba, Dominican Republic, Egypt, Greece, India, Kosovo, Lebanon, Lithuania, Macedonia, Malaysia, Mexico, Morocco, Pakistan, Panama, Peru, Philippines, Poland, Salvador, Saudi Arabia, Serbia, Singapore, Slovakia, Sudan, Thailand, Turkey, Uruguay, and Vietnam) from 4 continents (America, Asia, Africa, and Europe). PATIENTS: Patients undergoing surgical procedures (SPs) from January 2005 to December 2010. METHODS: Data were gathered and recorded from patients hospitalized in INICC member hospitals by using the methods and definitions of the CDC-NHSN for SSI. SPs were classified into 31 types, according to the ninth edition of the International Classification of Diseases (ICD-9) criteria. RESULTS: We gathered data from of 7,523 SSIs, associated with 260,973 SPs. SSIs rates were significantly higher in most SPs of INICC hospitals compared with CDC-NSHN data, including the rates SSI following hip prosthesis, 2.6%, vs. 1.3% (RR, 2.06; 95%CI, 1.8– 2.4; P