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      Factores de riesgo e infección del sitio quirúrgico en procedimientos de cirugía ortopédica con prótesis Translated title: Risk factors related to surgical site infection in orthopedic prosthesis surgery

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          Abstract

          Objetivo: Identificar factores de riesgo para infecciones del sitio quirúrgico en pacientes con fracturas quirúrgicas de manejo con material de osteosíntesis o prótesis. Material y Método: Se realizó un estudio de corte transversal en una institución de tercer nivel de Armenia- Colombia en 2008 y 2009 en 223 pacientes. Resultados: La frecuencia de infección incisional superficial fue de 9,4% (n: 21), y de incisional profunda 7,6% (n: 17); no hubo infecciones de órgano/espacio; las mayores frecuencias de infección se observaron en fracturas de rótula (50%), articulación acromio- clavicular (25%) y fémur (23,7%). La etiología infecciosa fue por: Staphylococcus aureus, Enterobacter gergoviae y Enterobacter aerogenes. Se encontró asociación con heridas limpia-contaminadas comparadas con heridas limpias (OR 2,2), fracturas conminutas (OR 2,1), fracturas múltiples (OR 2,9), y cirugía de rótula (OR 3,1). Conclusiones: La gravedad de la fractura y el grado de contaminación se evidenciaron como predisponentes para infección.

          Translated abstract

          Objective: to identify the risk factors for surgical site infections (SSI) in patients with surgical management fractures with internal fixation or prosthetic material. Materials and Methods: a cross-sectional study was conducted in a tertiary institution in Armenia-Colombia in 2008 and 2009 in 223 patients. Results: The superficial incisional infection frequency was 9,4% (n: 21), and deep incisional infection was 7,6% (n: 17); there were no organ/space SSI.; the highest rates of infection were observed in patella fractures (50%), acromio-clavicular joint (25%), and femur (23,7%). The infections were caused by: S. aureus, Enterobactergergoviae y Enterobacteraerogenes. There was an association with clean-contaminated wounds compared to clean wounds (OR 2,2), comminuted fractures (OR 2,1) multiple fractures (OR 2,9) and patella surgery (OR 3,1). Conclusions: the severity of the fracture and the degree of contamination were predisposing factors to infection.

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          Invasive methicillin-resistant Staphylococcus aureus infections in the United States.

          As the epidemiology of infections with methicillin-resistant Staphylococcus aureus (MRSA) changes, accurate information on the scope and magnitude of MRSA infections in the US population is needed. To describe the incidence and distribution of invasive MRSA disease in 9 US communities and to estimate the burden of invasive MRSA infections in the United States in 2005. Active, population-based surveillance for invasive MRSA in 9 sites participating in the Active Bacterial Core surveillance (ABCs)/Emerging Infections Program Network from July 2004 through December 2005. Reports of MRSA were investigated and classified as either health care-associated (either hospital-onset or community-onset) or community-associated (patients without established health care risk factors for MRSA). Incidence rates and estimated number of invasive MRSA infections and in-hospital deaths among patients with MRSA in the United States in 2005; interval estimates of incidence excluding 1 site that appeared to be an outlier with the highest incidence; molecular characterization of infecting strains. There were 8987 observed cases of invasive MRSA reported during the surveillance period. Most MRSA infections were health care-associated: 5250 (58.4%) were community-onset infections, 2389 (26.6%) were hospital-onset infections; 1234 (13.7%) were community-associated infections, and 114 (1.3%) could not be classified. In 2005, the standardized incidence rate of invasive MRSA was 31.8 per 100,000 (interval estimate, 24.4-35.2). Incidence rates were highest among persons 65 years and older (127.7 per 100,000; interval estimate, 92.6-156.9), blacks (66.5 per 100,000; interval estimate, 43.5-63.1), and males (37.5 per 100,000; interval estimate, 26.8-39.5). There were 1598 in-hospital deaths among patients with MRSA infection during the surveillance period. In 2005, the standardized mortality rate was 6.3 per 100,000 (interval estimate, 3.3-7.5). Molecular testing identified strains historically associated with community-associated disease outbreaks recovered from cultures in both hospital-onset and community-onset health care-associated infections in all surveillance areas. Invasive MRSA infection affects certain populations disproportionately. It is a major public health problem primarily related to health care but no longer confined to intensive care units, acute care hospitals, or any health care institution.
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            Treatment of infections associated with surgical implants.

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              Health and Economic Impact of Surgical Site Infections Diagnosed after Hospital Discharge

              Although surgical site infections (SSIs) are known to cause substantial illness and costs during the index hospitalization, little information exists about the impact of infections diagnosed after discharge, which constitute the majority of SSIs. In this study, using patient questionnaire and administrative databases, we assessed the clinical outcomes and resource utilization in the 8-week postoperative period associated with SSIs recognized after discharge. SSI recognized after discharge was confirmed in 89 (1.9%) of 4,571 procedures from May 1997 to October 1998. Patients with SSI, but not controls, had a significant decline in SF-12 (Medical Outcomes Study 12-Item Short-Form Health Survey) mental health component scores after surgery (p=0.004). Patients required significantly more outpatient visits, emergency room visits, radiology services, readmissions, and home health aide services than did controls. Average total costs during the 8 weeks after discharge were US$5,155 for patients with SSI and $1,773 for controls (p<0.001).
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                Author and article information

                Journal
                rci
                Revista chilena de infectología
                Rev. chil. infectol.
                Sociedad Chilena de Infectología (Santiago, , Chile )
                0716-1018
                August 2012
                : 29
                : 4
                : 395-400
                Affiliations
                [01] Armenia orgnameUniversidad del Quindío orgdiv1Facultad de Ciencias de la Salud orgdiv2Programa de Medicina Colombia
                Article
                S0716-10182012000400005 S0716-1018(12)02900400005
                10.4067/S0716-10182012000400005
                6a6078fa-240c-4de7-b301-bb34a3359865

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 10 June 2011
                : 03 May 2012
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 21, Pages: 6
                Product

                SciELO Chile

                Categories
                INFECCIONES ASOCIADAS A ATENCIÓN DE SALUD

                handwashing,infección de herida operatoria,Prosthesis-related,hospital infections,Infecciones relacionadas con prótesis,surgical wound,infección hospitalaria,infection control,infections,control de infecciones,infection,lavado de manos

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