Fatores associados à gravidade da infecção de sítio cirúrgico em pacientes de um hospital público do Nordeste brasileiro

Abstract

Surgical Site Infections (SSIs) are classified into three levels of severity: superficial, deep, and organ/space infections. This type of infection remains a concern for healthcare services, primarily due to its negative consequences for both patients and hospital institutions. The objective of this study was to analyze the factors associated with the severity of SSIs in surgical patients at a public hospital in northeastern Brazil. This is a cross-sectional study conducted between September 2023 and April 2024, based on the identification of SSI cases from 2017 to 2023 in the infection control service of the participating hospital unit, followed by a review of physical and electronic medical records for data collection. Statistical analysis included calculating absolute and relative frequencies, mean, standard deviation, and rates, as well as Fisher’s Exact Test, one-way ANOVA, and Kruskal-Wallis tests, adopting a significance level of p < 0,05. A total of 238 SSI cases were identified in the hospital unit, distributed among 108 cases in adults (≥18 years old) and 23 cases in pediatric and neonatal patients who underwent surgery in the general surgical center, along with 107 SSI cases in women who underwent surgery in the obstetric surgical center. Among adult patients in the general surgical center, a significant association was found between infection severity and variables such as postoperative hospital stay (p = 0,009), total hospitalization time (p = 0,010), use of general anesthesia (p = 0,037), type of surgical approach (p = 0,029), presence of signs and symptoms of infection in the postoperative period (p = 0,001), need for surgical reintervention (p = 0,033), leukocyte count (p = 0,004), number of medication types used for treatment (p = 0,010), sepsis (p = 0,021), blood culture performed (p = 0,002), positive blood culture (p = 0,013), and need for intensive care (p = 0,002). In the obstetric surgical center, infection severity was associated with postoperative hospital stay (p = 0,039), total hospitalization time (p = 0,044), need for reintervention (p = 0,001), days of antibiotic therapy (p = 0,000), number of medication types used for treatment (p = 0,010), and the occurrence of sepsis (p = 0,000). In pediatrics and neonatology, infection severity was associated with the postoperative referral location (p = 0,011) and surgery duration (p = 0,017). The highest infection rate in the general surgical center was recorded in 2021, at 4,0%, while in the obstetric surgical center, cesarean sections in 2019 had the highest rate, at 2,88%. The data highlight factors contributing to the severity of SSIs, related to the patient, the procedure, and healthcare assistance, emphasizing the need to continuously improve and implement preventive protocols and measures.