Evaluation of routinely reported surgical site infections against microbiological culture results: a tool to identify patient groups where diagnosis and treatment may be improved

Marco Krukerink,Perla J Marang-Van De Mheen,Job Kievit

doi:10.1186/1471-2334-9-176

Marco Krukerink, Perla J Marang-Van De Mheen + Show 1 more

Open Access

https://doi.org/10.1186/1471-2334-9-176

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Abstract

BackgroundSurgeons may improve their decision making by assessing the extent to which their initial clinical diagnosis of a surgical site infection (SSI) was supported by culture results. Aim of the present study was to evaluate routinely reported SSI by surgeons against microbiological culture results, to identify patient groups with lower agreement where decision making may be improved.Methods701 admissions with SSI were reported by surgeons in a university medical centre in the period 1997-2005, which were retrospectively checked for microbiological culture results. Reporting a SSI was conditional on treatment being given (e.g. antibiotics) and was classified by severity. To identify specific patient groups, patients were classified according to the surgery group of the first operation during admission (e.g. trauma).ResultsOf all reported SSI, 523 (74.6%) had a positive culture result, 102 (14.6%) a negative culture result and 76 (10.8%) were classified as unknown culture result (due to no culture taken). Given a known culture result, reported SSI with positive culture results less often concerned trauma patients (16% versus 26%, X2 = 4.99 p = 0.03) and less severe SSI (49% versus 85%, X2 = 10.11 p < 0.01) suggesting that a more conservative approach may be warranted in these patients. The trauma surgeons themselves perceived to have become too liberal in administering antibiotics (and reporting SSI).ConclusionRoutine reporting of SSI was mostly supported by culture results. However, this support was less often found in trauma patients and less severe SSI, thereby giving surgeons feedback that diagnosis and treatment may be improved in these cases.

Highlights

Surgeons may improve their decision making by assessing the extent to which their initial clinical diagnosis of a surgical site infection (SSI) was supported by culture results
SSI with unknown culture results were less often diagnosed in males, less often highrisk patients and more often concerned the less severe SSI that do not require reoperation
(page number not for citation purposes) http://www.biomedcentral.com/1471-2334/9/176. We further examined these SSI with unknown culture results to explore the reasons for not obtaining a culture

Summary

Introduction

Surgeons may improve their decision making by assessing the extent to which their initial clinical diagnosis of a surgical site infection (SSI) was supported by culture results. Aim of the present study was to evaluate routinely reported SSI by surgeons against microbiological culture results, to identify patient groups with lower agreement where decision making may be improved. BMC Infectious Diseases 2009, 9:176 http://www.biomedcentral.com/1471-2334/9/176 patients and hospitals [2,3]. For these reasons, both medical professionals and policy makers in hospitals are interested in monitoring SSI. The most commonly used definition is that as defined by the Centers for Disease Control and prevention (CDC) National Nosocomial Infection Survey (NNIS) [6]. The CDC NNIS definition is advocated to be adopted as the universal, single, definition of SSI [7], as it is known that even small differences in definition may result in large differences in outcome, making comparisons between definitions unreliable [6]

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