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Increase in surgical site infections caused by gram-negative bacteria in warmer temperatures: Results from a retrospective observational study

Published online by Cambridge University Press:  07 October 2020

Seven Johannes Sam Aghdassi Open the ORCID record for Seven Johannes Sam Aghdassi [Opens in a new window] ,
Petra Gastmeier ,
Peter Hoffmann  and
Frank Schwab
Seven Johannes Sam Aghdassi*
Affiliation:
Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
Petra Gastmeier
Affiliation:
Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
Peter Hoffmann
Affiliation:
Potsdam Institute for Climate Impact Research, Climate Resilience, Potsdam, Germany
Frank Schwab
Affiliation:
Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
*
Author for correspondence: Seven Johannes Sam Aghdassi, E-mail: seven-johannes-sam.aghdassi@charite.de
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Abstract

Objective:

Surgical site infections (SSIs) occur more frequently during periods of warmer temperatures. We aimed to investigate for which pathogens this association is particularly strong.

Design:

A retrospective observational study was conducted.

Methods:

Data from the SSI-module of the German nosocomial infection surveillance system between 2000 and 2016 were linked with data from the German Meteorological Service. Patient- and procedure-related data were associated with monthly aggregated meteorological data. Due to high correlation with other meteorological parameters, we focused on the outside temperature. Adjusted odds ratios were calculated for SSI rates relating to temperature. SSIs were stratified by pathogen. A P value of <.05 was considered significant.

Results:

Altogether, 2,004,793 procedures resulting in 32,118 SSIs were included. Generally, warmer temperatures were associated with a higher SSI risk, especially for SSIs with gram-negative pathogens. This association was particularly prominent for Acinetobacter spp, Pseudomonas aeruginosa, and certain Enterobacteriaceae. Per additional 1°C, we observed a 6% increase in the SSI risk for Acinetobacter spp and a 4% increase for Enterobacter spp. Superficial SSIs with Acinetobacter spp were 10 times more likely to occur when comparing surgeries in months with mean temperatures of ≥20°C to mean temperatures of <5°C.

Conclusions:

Higher temperatures were associated with increased SSI rates caused by gram-negative bacteria. Future SSI prevention measures should consider this aspect. Underlying shifts in microbiome composition due to climate factors should be included in further analyses. Given the expected rise of global temperatures until the end of the century, this topic has relevance from multiple perspectives.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 4 , April 2021 , pp. 417 - 424
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION. A previous publication that utilized the same data set was published in August 2019 in the German journal Deutsches Ärzteblatt International (https://doi.org/10.3238/arztebl.2019.0529), where first results on the matter were presented, but no distinction between different pathogens was made. An abstract on the data presented in this manuscript was accepted for presentation at the Sixth International Conference on Healthcare Associated Infections, which was scheduled to be held March 26–30, 2020, in Atlanta, Georgia, but was cancelled due to the COVID-19 pandemic.

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