Inpatient antimicrobial exposure screening identified surgical site infections with 88% to 91% sensitivity, compared to 38% to 64% for routine surveillance.
Cohort (n=22,313)
Yes
Does screening by antimicrobial exposure and discharge diagnoses improve the detection of surgical site infections compared to routine surveillance in inpatients undergoing surgical procedures?
Screening based on inpatient antimicrobial exposure and discharge diagnosis codes is a highly sensitive and efficient method for identifying surgical site infections compared to traditional routine surveillance.
We evaluated antimicrobial exposure, discharge diagnoses, or both to identify surgical site infections (SSI). This retrospective cohort study in 13 hospitals involved weighted, random samples of records from 8,739 coronary artery bypass graft (CABG) procedures, 7,399 cesarean deliveries, and 6,175 breast procedures. We compared routine surveillance to detection through inpatient antimicrobial exposure (> 9 days for CABG, > 2 days for cesareans, and > 6 days for breast procedures), discharge diagnoses, or both. Together, all methods identified SSI after 7.4% of CABG, 5.0% of cesareans, and 2.0% of breast procedures. Antimicrobial exposure had the highest sensitivity, 88%-91%, compared with routine surveillance, 38%-64%. Diagnosis codes improved sensitivity of detection of antimicrobial exposure after cesareans. Record review confirmed SSI after 31% to 38% of procedures that met antimicrobial surveillance criteria. Sufficient antimicrobial exposure days, together with diagnosis codes for cesareans, identified more postoperative SSI than routine surveillance methods. This screening method was efficient, readily standardized, and suitable for most hospitals.
Yokoe et al. (2004) conducted a cohort in Surgical site infections (n=22,313). Inpatient antimicrobial exposure and discharge diagnosis codes vs. Routine surveillance was evaluated on Sensitivity for detecting surgical site infections. Inpatient antimicrobial exposure screening identified surgical site infections with 88% to 91% sensitivity, compared to 38% to 64% for routine surveillance.