Abstract
Background:
The quality of life of the HIV-infected population in developed countries has substantially improved over the years. Accordingly, the clinical limitations in the surgical treatment of the HIV-infected patients are becoming fewer, and the number of HIV-infected patients undergoing surgical interventions of all types is increasing. However, available data on the incidence and risk factors for post-surgical complications, such as surgical site infections (SSI), in HIVinfected patients are still limited and often controversial. The aim of this study was to determine the incidence and the associated risk factors for SSI in HIV-infected patients.
Methods:
A 1-year observational prospective multicenter surveillance study was conducted in 11 Italian Infectious Diseases Clinical Centers from which 305 consecutive HIVinfected patients undergoing different surgical procedures were enrolled. Postdischarge surveillance was conducted within 30 days after surgery. A number of variables were included in a multivariate analysis aimed at assessing potential risk factors for SSI, including body mass index, diabetes, Hepatitis C (HCV) and hepatitis B virus infection, lipodistrophy, HIV viral load, CD4 cell count and white blood cell count, preoperative hospital stay, National Nosocomial Infection Surveillance (NNIS) risk score, and any antimicrobial prophylaxis.
Results:
SSI occurred in 29 of 305 (9.5%) patients, of which 17 (58.6%) SSI occurred during hospital stay, and 12 (41.4%) occurred during the postdischarge period. The SSI of the 29 patients were classified as superficial (21, 72.4%), deep (four, 13.8%), organ/space (one, 3.4%), and sepsis (three, 10.3%). Nearly 50% of the superficial and 50% of the deep SSI occurred during the postdischarge period. Organ/space infection and sepsis accounted for 13.7% of all SSI and were observed during the in-hospital stay. The multivariate analysis revealed that HCV co-infection was significantly associated to SSI occurrence. Total hospital stay was longer among patients with SSI than among those without SSI (p = 0.041).
Conclusion:
Although 92.5% of our HIV-infected patients presented a NNIS score ≤ 1, the SSI rate was twofold higher than that reported in Italian and European studies for the general population, with more severe clinical presentations. This is the first report of an association between HCV–HIV co-infection and SSI occurrence. Additionally, the viroimmunological status of our patients was not related to SSI occurrence, which suggests the need for further research for other potential risk factors that may be implicated in the occurrence of SSI.
Article PDF
Avoid common mistakes on your manuscript.
References
Burgoyne RW, Tan DH: Prolongation and quality of life for HIV-infected adults treated with highly active antiretroviral therapy (HAART): a balancing act. J Antimicrob Chemother 2008; 61: 469–473.
Bucciardini R, Fragola V, Massella M, Polizzi C, Mirra M, Goodall R, Carey D, Hudson F, Zajdenverg R, Floridia M, Initio Trial International Coordinating Committee: Health-related quality of life outcomes in HIV-infected patients starting different combination regimens in a randomized multinational trial: the INITIO-QoL substudy. AIDS Res Hum Retrovir 2007; 10: 1215–1222.
Saltzman DJ, Williams RA, Gelfand DV, Wilson SE: The surgeon and AIDS. Arch Surg 2005; 140: 961–967.
Miro JM, Aguero F, Laguno M, Tuset M, Cervera C, Moreno A, Garcia-Valdecasas JC, Rimola A: Liver transplantation in HIV/hepatitis co-infection. J HIV Ther 2007; 121: 24–35.
Vennarecci G, Ettorre GM, Antonini M, Santoro R, Perracchio L, Visco G, Santoro E: Liver transplantation in HIV-positive patients. Transplant Proc 2007; 39: 1936–1938.
Schreibman I, Gaynor JJ, Jayaweera D, Pyrsopoulos N, Weppler D, Tzakis A, Schiff ER, Regev A: Outcomes after orthotopic liver transplantation in 15 HIV-infected patients. Transplantation 2007; 84: 697–705.
Fiorio M, Marvaso A, Viganò F, Marchetti F: Incidence of surgical site infections in general surgery in Italy. Infection 2006; 34: 310–314.
Karnofsky DA, Burchenal JH: The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM (ed) Evaluation of chemotherapeutic agents. Columbia University Press, London 1949, p 196.
Horan, TC, Gaynes, RP, Martone WJ, Jarvis WR, Emori TG: CDC definitions of nosocomial surgical site infections: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992; 13: 606–608.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G: International Sepsis Definitions Conference. 2001SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med 2003; 29: 530–538.
Culver DH, Horan TC, Gaynes RP, Maratone WJ, Jarvis WR, Emori TG, Banerjee SN, Edwards JR, Tolson JS, Henderson TS, Hughes JM: Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med 1991; 91: 152S–157S.
Ferrero S, Bentivoglio G: Post-operative complications after caesarean section in HIV-infected women. Arch Gynecol Obstet 2003; 268: 268–273.
Maiques-Montesinos V, Cervera-Sanchez J, Bellver-Pradas J, Abad-Carrascosa A, Serra-Serra V: Post-cesarean section morbidity in HIV-positive women. Acta Obstet Gynecol Scand 1999; 78: 789–792.
Vimercati A, Greco P, Loverro G, Lopalco PL, Pansini V, Selvaggi L: Maternal complications after caesarean section in HIV infected women. Eur J Gynecol Reprod Biol 2000; 90: 73–76.
Rodriguez EJ, Spann C, Jamieson D, Lindsay M: Postoperative morbidity associated with cesarean delivery among human immunodeficiency virus-seropositive women. Am J Obstet Gynecol 2001; 184: 1108–1111.
Farzan F, Salzberg SP, van Harbou KTJ, Neibart E, Adams DH: Excellent outcomes of cardiac surgery in patients infected with the HIV in current era. Clin Infect Dis 2006; 43: 532–536.
Trachiotis GD, Alexander EP, Benator D, Gharagozloo F: Cardiac surgery in patients infected with the human immunodeficiency virus. Ann Thorac Surg 2003; 76: 1114–1118.
Hoekman P, van de Perre P, Nelissen J, Kwisanga B, Bogaerts J, Kanjangabo F: Increased frequency of infection after open reduction of fractures in patients who are seropositive for Human Immunodeficiency Virus. J Bone Joint Surg Am 1991; 73: 675–679.
Harrison WJ, Lewis CP, Lavy CBD: Open fractures of the tibia in HIV positive patients: a prospective controlled single-blind study. Int J Care Inj 2004; 35: 852–856.
Skarda DE, Taylor JH, Chipman JG, Larson M, Baker JV, Schaker TW, Belman GJ: Inguinal lymph node biopsy in patients infected with the human immunodeficiency virus is safe. Surg Infect 2007; 8: 173–178.
Emparan C, Iturburu IM, Portugal V, Apecechea A, Bilbao JE, Mendez JJ: Infective complications after minor operations in patients infected with the HIV: role of CD4 lymphocytes in prognosis. Eur J Surg 1995; 161: 721–723.
Nicastri E, Petrosillo N, Martini L, Larosa M, Gesu GP, Ippolito G, The INF NOS Study Group: Prevalence of nosocomial infections in 15 Italian hospitals: first point prevalence study for the INFNOS Project. Infection 2003; 31: 16–22.
Greco D, Moro ML, Tozzi AE, De Giacomi GV: Effectiveness of an intervention program in reducing postoperative infections. Infection 2003; 31: 164–169.
Reilly J, Allardice G, Bruce J, Hill R, McCoubrey J: Procedure-specific surgical site infection rates and postdishcarge surveillance in Scotland. Infect Control Hosp Epidemiol 2006; 27: 1318–1323.
Delgado-Rodriguez M, Gomez-Ortega A, Sillero-Arenas M, Liorca J: Epidemiology of surgical-site infections diagnosed after hospital discharge: a prospective cohort study. Infect Control Hosp Epidemiol 2001; 22: 24–30.
Padoveze MC, Tresoldi AT, von Nowakonski A, Aoki FH, Branchini ML: Nasal MRSA colonization of AIDS patients cared for in a Brazilian university hospital. Infect Control Hosp Epidemiol 2001; 22: 783–785.
Paiment GD, Hymes RA, La Douceur MS, Gosselin RA, Green HD: Postoperative infections in asymptomatic HIV-seropositive orthopedic trauma patients. J Trauma 1994; 37: 545–550.
Jaén A, Esteve A, Mirò JM, Tural C, Montoliu A, Ferre E, Riera M, Segura F, Force L, Sued O, Vilarò J, Garcia I, Masabeu A, Altès J, Coltet B, Podzamczer D, Murillas J, Navarro G, Gatell JM, Casabona J, PISCIS Study Group: Determinants of HIV progression and assessment of the optimal time to initaite highly active antiretroviral therapy: PISCIS Cohort (Spain). J Acquir Immune Defic Syndr 2008; 47: 212–220.
Bruno R, Sacchi P, Puoti M, Maiochci L, Patruno S, Carosi G, Filice G: Natural history of compensated viral cirrosi in a color of patients with HIV infection. J Acquir Immune Defic Sundr 2007; 46: 297–303.
Smit C, van den Berg C, Geskus R, Berkhout B, Coutinho R, Prins M: Risk of hepatitis-related mortality increased among hepatitis C virus/HIV-coinfected drug users compared with drug users infected only with hepatitis C virus: a 20-year prospective study. J Acquir Immune Defic Syndr 2008; 47: 221–225.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Drapeau, C.M.J., Pan, A., Bellacosa, C. et al. Surgical site infections in HIV-infected patients: Results from an Italian prospective multicenter observational study. Infection 37, 455–460 (2009). https://doi.org/10.1007/s15010-009-8225-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s15010-009-8225-1