@article{3103383,
    title = "Surgical site infection after gastrointestinal surgery in children: An international, multicentre, prospective cohort study",
    author = "Harrison, E.M. and Drake, T.M. and Ghosh, D. and Ademuyiwa, A.O. and Bhangu, A. and Fitzgerald, J.E. and Glasbey, J. and Borda-Luque, G. and Costas-Chavarri, A. and Ntirenganya, F. and Fergusson, S.J. and Ingabire, J.C.A. and Ismaïl, L. and Lilford, R. and Mihaljevic, A.L. and Morton, D. and Mutabazi, A.Z. and Adisa, A.O. and Ots, R. and Pinkney, T. and Poškus, T. and Shaw, C.A. and Verjee, A. and Runigamugabo, E. and Khatri, C. and Mohan, M. and Jaffry, Z. and Altamini, A. and Kirby, A. and Soreide, K. and Cornick, J. and Iyer, D. and King, S. and Arthur, T. and Nahar, S.N. and Waterman, A. and Lawini, I. and Rouse, T. and Correa, J.C. and Salem, H.K. and Worku, M. and Arnaud, A. and Kalles, V. and Aguilera, M.L. and Recinos, G. and Quek, R. and Altibi, A. and Whitaker, J. and Bent, Z. and Al-Slaibi, I. and Tahboub, H. and Alser, O.H. and Shu, S. and Mironescu, A. and Bratu, M. and Altwijri, A. and Alsaggaf, M.U. and Jubran, A.F. and Seisay, S. and Jeyakumar, J. and Senanayake, K. and Abdulbagi, O. and Raptis, D. and Kong, C. and Suresh, S. and Scott, M. and Grizhja, B. and Ymeri, S. and Galiqi, G. and Klappenbach, R. and Antezana, D. and Beleño, A.E.M. and Costa, C. and Sanchez, B. and Aviles, S. and Modolo, M.M. and Fermani, C.G. and Balmaceda, R. and Villalobos, S. and Carmona, J.M. and Hamill, D. and Deutschmann, P. and Sandler, S. and Cox, D. and Nataraja, R. and Sharpin, C. and Ljuhar, D. and Gray, D. and Haines, M. and Iyer, D. and Niranjan, N. and D'Amours, S. and Ashtari, M. and Franco, H. and Mitul, A.R. and Karim, S. and Aman, N.F. and Estee, M.M. and Salma, U. and Razzaque, J. and Hamidkanta, T. and Tori, S. and Alamin, Md.S. and Roy, S. and Al Amin, Md.S. and Haque, M. and Faruq, A. and Iftekhar, F. and O'Shea, M. and Padmore, G. and Jonnalagadda, R. and Litvin, A. and Filatau, A. and Paulouski, D. and Shubianok, M. and Shachykava, T. and Khokha, D. and Khokha, V. and Djivoh, F. and Lawani, I. and Dossou, F. and Seto, D.M. and Gbessi, D.G. and Noukpozounkou, B. and Souaibou, Y.I. and Keke, K.R. and Hodonou, F. and Ahounou, E. and Alihonou, T. and Dénakpo, M. and Ahlonsou, G. and Bedada, A.G. and Nsengiyumva, C. and Kwizera, S. and Barendegere, V. and Choi, P. and Stock, S. and Jamal, L. and Firdouse, M. and Zani, A. and Azzie, G. and Kushwaha, S. and Agarwal, A. and Chen, T.-L. and Yip, C. and Montes, I. and Zapata, F. and Sierra, S. and Lanau, M.I.V. and Arango, M.C.M. and Restrepo, I.M. and Sierra, S. and Giraldo, R.S.R. and Mendozaarango, M. and Domini, E. and Karlo, R. and Mihanovic, J. and Youssef, M. and Elfeki, H. and Thabet, W. and Sanad, A. and Tawfik, G. and Zaki, A. and Abdel-Hameed, N. and Mostafa, M. and Omar, M.F.W. and Ghanem, A. and Abdallah, E. and Denewer, A. and Emara, E. and Rashad, E. and Sakr, A. and Elashry, R. and Emile, S. and Khafagy, T. and Elhamouly, S. and Elfarargy, A. and Mamdouhmohamed, A. and Saiednagy, G. and Esam, A. and Elwy, E. and Hammad, A. and Khallaf, S. and Ibrahim, E. and Saidbadr, A. and Moustafa, A. and Eldosoukymohammed, A. and Elgheriany, M. and Abdelmageed, E. and Al Raouf, E.A. and Elbanby, E. and Elmasry, M. and Morsyfarahat, M. and Yahyamansor, E. and Magdyhegazy, E. and Gamal, E. and Gamal, H. and Kandil, H. and Maherabdelrouf, D. and Moaty, M. and Gamal, D. and El-Sagheer, N. and Salah, M. and Magdy, S. and Salah, A. and Essam, A. and Ali, A. and Badawy, M. and Ahmed, S. and Mohamed, M. and Assal, A. and Sleem, M. and Ebidy, M. and Abdelrazek, A. and Zahran, D. and Adam, N. and Nazir, M. and Hassanein, A.B. and Ismail, A. and Elsawy, A. and Mamdouh, R. and Mabrouk, M. and Ahmed, L.A.M. and Hassabalnaby, M. and Magdy, E. and Abd-Elmawla, M. and Fahim, M. and Mowafy, B. and Mahmoud, M.I. and Allam, M. and Alkelani, M. and El Gendy, N.H. and Aboul-Naga, M.S. and Alaael-Din, R. and Elgendy, A.H. and Ismail, M. and Shalaby, M. and Elsharkawy, A.A. and Moghazy, M.E. and Elbisomy, K.H. and Shakshouk, H.A.G. and Hamed, M.F. and Ebidy, M.M. and Abdelkader, M. and Karkeet, M. and Ahmed, H. and Adel, I. and Omar, M.E. and Ibrahim, M. and Ghoneim, O. and Hesham, O. and Gamal, S. and Hilal, K. and Arafa, O. and Awad, S.A. and Salem, M. and Elsherif, F.A. and Elsabbagh, N. and Aboelsoud, M.R. and Rida, A.H.E.F. and Hossameldin, A. and Hany, E. and Asar, Y.H. and Anwar, N. and Gadelkarim, M. and Abdelhady, S. and Morshedy, E.M. and Saad, R. and Soliman, N. and Salama, M. and Ezzat, E. and Mohamed, A. and Ibrahim, A. and Fergany, A. and Mohammed, S. and Reda, A. and Allam, Y. and Saad, H.A. and Abdelfatah, A. and Fathy, A.M. and El-Sehily, A. and Kasem, E.A. and Hassan, A.T.A. and Mohammed, A.R. and Saad, A.G. and Elfouly, Y. and Elfouly, N. and Ibrahim, A. and Hassaan, A. and Mohammed, M.M. and Elhoseny, G. and Magdy, M. and Elkhalek, E.A. and Zakaria, Y. and Ezzat, T. and El Dahab, A.A. and Kelany, M. and Arafa, S. and Hassan, O.M.M. and Badwi, N.M. and Sleem, A.S. and Ahmed, H. and Abdelbadeai, K. and Abdullah, M.A. and Lokman, 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Farhan-Alanie, M.M.H. and Callan, R. and Chibuye, C. and Ali, T.H.A. and Rekhis, S. and Rommaneh, M. and Sam, Z.H. and Lawani, I. and Pugliesi, T.B. and Pardo, G. and GlobalSurg Collaborative",
    journal = "BMJ Global Health",
    year = "2020",
    volume = "5",
    number = "12",
    publisher = "BMJ Publishing Group",
    issn = "2059-7908",
    doi = "10.1136/bmjgh-2020-003429",
    abstract = "Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45·1%) children were from high HDI, 397 (34·2%) from middle HDI and 239 (20·6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12·8% (51/397) in middle HDI and 24·7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda. ©"
}