Enhanced identification of postoperative infections among inpatients

Emerg Infect Dis. 2004 Nov;10(11):1924-30. doi: 10.3201/eid1011.040572.


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.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Cesarean Section / adverse effects
  • Coronary Artery Bypass / adverse effects
  • Cross Infection / diagnosis
  • Cross Infection / drug therapy
  • Cross Infection / etiology
  • Humans
  • Inpatients
  • Mammaplasty / adverse effects
  • Patient Discharge
  • Population Surveillance / methods*
  • Surgical Wound Infection / diagnosis*
  • Surgical Wound Infection / drug therapy
  • Surgical Wound Infection / etiology


  • Anti-Bacterial Agents