Analysis of risk factors for nosocomial sepsis in surgical patients

Background: This study aimed to identify patients at high risk for developi ng sepsis following surgery according to criteria determined by the America n College of Chest Physicians and the Society of Critical Care Medicine Con sensus Conference on sepsis. Methods: A prospective case-control study was performed in surgical patient s in a tertiary care centre over 1 year. Patients were identified by a dail y prospective surveillance. Controls were selected randomly from the daily list of surgical inpatients. Data were collected prospectively. Crude and a djusted odds ratios (ORs) and their 95 per cent confidence intervals were c omputed using logistic regression analysis. Results: During follow-up, 99 cases and 99 controls were identified. The ma in risk factors for sepsis found in the multivariate analysis were coma wit hin 48 h before sepsis (OR 13.5, 95 per cent confidence interval 3.6-50.8), low serum albumin level at admission (OR 15.8, 5.4-46.4), two or more intr insic comorbidities (OR 11.8, 2.8-49.4) and parenteral nutrition (OR 5.1, 1 .5-17.1). Emergency surgery (OR 3.0, 1.4-6.4), abdominal surgery (OR 2.6, 1 .0-6.8) and number of surgical interventions (OR 2.5, 1.1-6.1) were the var iables related to surgery that significantly increased the risk of sepsis, Both the study on the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infections Surveillance indices showed a statistica lly significant trend with sepsis. Conclusion: Patient-related factors appear to represent the greatest risk f or developing postoperative nosocomial sepsis, rather than factors associat ed with the surgery.