Fifteen-year trends in groin wound infection after femoral vascular access: Incidence, severity, and microbiological shifts in a tertiary center cohort

Introduction. Wound infection after groin incision remains a frequent complication in vascular surgery, yet long-term singlecenter data on temporal trends, severity distribution, and pathogen shifts are scarce in southeastern Europe. This study describes the 15-year epidemiology of groin wound infection following femoral vascular procedures and examines changes in incidence, wound depth classification, and methicillin-resistant Staphylococcus aureus prevalence. Material and Methods. All consecutive groin incisions for femoral arterial access performed at a single tertiary vascular center between January 2010 and December 2024 were reviewed. Wound infection was diagnosed within 90 days using standardized surveillance criteria. Annual rates were calculated and tested for temporal trend. Culture results were analyzed by five-year period. Results. Among 8,742 groin incisions, 846 (9.7%) developed a wound infection: 490 superficial (57.9%), 245 deep (29%), and 111 organ/space (13.1%). Annual rates fluctuated between 8.2% and 11.5% without a significant directional trend (p = 0.284). The highest unadjusted rate was observed after infrainguinal bypass (13%). Of 724 culture-positive episodes, the methicillin-resistant Staphylococcus aureus proportion rose across three predefined five-year periods, from 8.7% in 2010-2014 to 13.8% in 2015-2019 and 21% in 2020-2024 (p for trend < 0.001), while gram-negative isolates remained relatively stable at 23-26%. Conclusion. Groin wound infection affected approximately one out of ten femoral vascular procedures over 15 years with no measurable decline across the observation period. The steady rise in methicillin-resistant Staphylococcus aureus supports institutional review of empirical prophylaxis protocols at centers with similar resistance profiles.