Prevalence and incidence of surgical site infections in the European Union/European Economic Area: how do these measures relate?

BACKGROUND: In 2011-2012, the European Centre for Disease Prevention and Control (ECDC) initiated the first European point prevalence survey (PPS) of healthcare-associated infections (HCAIs) in addition to targeted surveillance of the incidence of specific types of HCAI such as surgical site infections (SSIs). AIM: To investigate whether national and multi-country SSI incidence can be estimated from ECDC PPS data. METHODS: In all, 159 hospitals were included from 15 countries that participated in both ECDC surveillance modules, aligning surgical procedures in the incidence surveillance to corresponding specialties from the PPS. National daily prevalence of SSIs was simulated from the incidence surveillance data, the Rhame and Sudderth (R&S) formula was used to estimate national and multi-country SSI incidence from the PPS data, and national incidence per specialty was predicted using a linear model including data from the PPS. FINDINGS: The simulation of daily SSI prevalence from incidence surveillance of SSIs showed that prevalence fluctuated randomly depending on the day of measurement. The correlation between the national aggregated incidence estimated with R&S formula and observed SSI incidence was low (correlation coefficient = 0.24), but specialty-specific incidence results were more reliable, especially when the number of included patients was large (correlation coefficients ranging from 0.40 to 1.00). The linear prediction model including PPS data had low proportion of explained variance (0.40). CONCLUSION: Due to a lack of accuracy, use of PPS data to estimate SSI incidence is recommended only in situations where incidence surveillance of SSIs is not performed, and where sufficiently large samples of PPS data are available.

[Management of gas gangrene in Hungary during 1979-1988 based on data from Public Health Centers]. / A gázgangréna kezelése Magyarországon 1979-1988-ban a KOJAL-ok adatai alapján.

Authors present data on the therapy of 223 gas gangrene cases between 1979-1988, a ten years period, based on the reports of Public Health Stations in Hungary. Of the 223 patients 150 died, thus lethality was 67.3%. In lack of surgical intervention there was no chance of survive. Merely wound exposure resulted in a much higher fatality rate than necrectomy of the wound. Local hydrogen-hyperoxide treatment improved survival essentially. Specific antitoxin therapy did not influence the survival rate. The effect of a single antibiotic was poor; combined antibiotic treatment gave a significantly better result. As for combination, the most effective were erythromycin, the lincosamids and chloramphenicol. According to the data presented, it would be possible to reduce to the half the fatality rate of gas gangrene in Hungary.

[Gas gangrene cases in Hungary 1979-1986]. / Gázgangraena megbetegedések Magyarországon 1979-1986-ban.

The authors evaluate epidemiologic data of 182 patients suffering from gas gangrene during an eight year period from 1979 to 1986. Of the patients surveyed 127 died; thus lethality reached 69.2%. The average age of the survivors was 49.9 year as opposed to the 66.1 year of the fatal cases. More than half of the illnesses followed amputation of extremities, and a quarter of them was a consequence of an accident. Samples of the bacteriologically examined wound discharges yielded in 93.1% bacteria from the Clostridium genus. Hygiene was poor in operation theatres and in the hospital environment in 1/4-th of the cases. Sixty six patients died within 24 hours after diagnosis. The presented data suggest that in Hungary the number of gas gangrene cases and deaths surpass those of tetanus.