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AllenMutabazi, Alphonse ZetaUzabumwana, NorbertJovine, ElioZanini, NicolaLandolfo, GiovanniAljiffry, MuradIdris, FaisalAlghamdi, Mohammed Saleh A.Maghrabi, AshrafAltaf, AbdulmalikAlkaaki, AroubKhoja, AhmadNawawi, AbrarTurkustani, SondosKhalifah, EyadGudal, AhmadAlbiety, AdelSahel, SarahAlshareef, RehamNajjar, MohammedAlzahrani, AhmedAlghamdi, AhmedAlhazmi, WedyanAl Saied, GhiathAlamoudi, MohammedRiaz, Muhammed MasoodHassanain, MazenAlhassan, BasmahAltamimi, AbdullahAlyahya, ReemAl Subaie, NorahAl Bastawis, FatemaAltamimi, AfnanNouh, ThamerKhan, RoaaRadojkovic, MilanJeremic, LjiljanaNestorovic, MilicaLaw, Jia HaoTan, Keith Say KwangTan, Ryan Choon KiatTan, Joel KinJoel, Lau Wen LiangLieske, BettinaChan, Xue WeiLeong, Faith Qi HuiChong, Choon SengKoh, SharonLee, Kai YinLee, Kuok ChungPluke, KentDedekind, BrittaNashidengo, PuyearashidHampton, Mark IanJoosten, JohannaSobnach, SanjuRoodt, LianaSander, AnthonyPape, JamesSpence, RichardMaistry, NiveshniNdwambi, PhumudzoKinandu, KamauTun, MyintDu Toit, FrederickEllison, QuinnBurger, SuleGrobler, D. 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B.Thalgaspitiya, S. P. B.Wijayarathna, L. S.Wimalge, P. M. S. N.Sanni, Hakeem AyomiNdajiwo, AliyuOkenabirhie, OgheneochukoHomeida, AnmarYounis, AbobakerOmer, Omer AbdelbagiAbdulaziz, MustafaMussad, AliAdam, AliCengiz, YucelBjorklund, IdaAhlqvist, SandraAhlqvist, SandraThorell, AndersWogensen, FredrikSokratous, ArestisBreistrand, MichaelaThorarinsdottir, HildurSigurdadottir, JohannaNikberg, MaziarChabok, AbbasHjertberg, MariaElbe, PeterSaraste, DeborahRutkowski, WiktorForlin, LouiseNiska, KaroliinaSund, MalinOswald, DennisPeros, GeorgiosBluelle, RafaelReinisch, KatharinaFrey, DanielPalma, AdrianRaptis, Dimitri AristotleZumbuhl, LuciusZuber, MarkusSchmid, RogerWerder, GabrielaNocito, AntonioGerosa, AlexandraMahanty, SilkeWidmer, Lukas WernerMueller, JuliaGubeli, AlissaZuk, GrzegorzGulcicek, Osman BilginAltinel, YukselVartanoglu, TalarKose, EminKarahan, Servet RustuAydin, Mehmet CanSahbaz, Nuri AlperHalicioglu, IlkayAlis, HalilSapci, IpekAdiyaman, CanPektas, Ahmet MuratCengiz, Turgut BoraTansoker, IlkanIsler, VedatcanCevik, MuazzezMutlu, DenizOzben, VolkanOzmen, Berk BarisBayram, SefaYolcu, SinemKobal, Berna BuseToto, Omer FarukCakaloglu, Haluk CemKarabulut, KaganMutlu, VahitOzkan, Bahar BusraCelik, SabanSemiz, AnilBodur, SelimGul, EnisburakMurutoglu, BusraYildirim, ReyyanBaki, Bahadir EmreArslan, EkinGuner, AliTomas, KadirWalker, NathanShrimanker, NikhitaStoddart, MichaelCole, SimonBreslin, RyanSrinivasan, RaviElshaer, MohamedHunter, KristinaAl-Bahrani, AhmedLiew, IgnatiusMairs, Nora GraceRocke, AlistairDick, LachlanQureshi, MobeenChowdhury, DebkumarWright, NaomiSkerritt, ClareKufeji, DorothyHo, AdrienneDissanayake, TharindraTennakoon, AthulaAli, WadahLim, Shujing JaneTan, CharleneO'Neill, StephenJones, CatrinKnight, StephenNassif, DimaSharma, AbhishekWarren, OliverWhite, RebeccaMehdi, AiaPost, NathanKalakouti, ElianaDashnyam, EnkhbatStourton, FrederickMykoniatis, IoannisCurrow, CheliseWong, FranciscaGupta, AshishShatkar, VeerannaLuck, JoshuaKadiwar, SurajSmedley, AlexanderWakefield, RebeccaHerrod, PhilipBlackwell, JamesLund, JonathanCohen, FraserBandi, AshwathGiuliani, StefanoBond-Smith, GilesPezas, TheodoreFarhangmehr, NedaUrbonas, TomasPerenyei, MiklosIreland, PhilipBlencowe, NatalieBowling, KirkBunting, DavidLongstaff, LydiaSmart, NeilKeogh, KennethJeon, HyunjinIqbal, Muhammad RafaihKhosla, ShivunJeffery, AnnaPerera, JamesTeasdale, EllaIbrahem, Ahmad AboelkassemAlhammali, TariqSalama, YahyaKabariti, RakanOram, ShaunKidd, ThomasCullen, FraserOwen, ChristopherWilson, MichaelChiu, SeehuiSarafilovic, HannahPloski, JenniferEvans, ElizabethAbbas, AtharKamya, SylviaIshak, NorzawaniBisset, CarlyAndress, CedarChin, Ye RuPatel, PriyaEvans, DavidJeffery, AnnaPerera, JamesHaslegrave, AidanBoggon, AdamLaurie, KirstenConnor, KatieMann, ThomasNepogodiev, DmitriMansuri, AnahitaDavies, RachelGriffiths, EwenShahbaz, Aized RazaEng, CalvinDin, FarhatL'Heveder, AriadnePark, Esther H. G.Ravishankar, RamanishMcIntosh, KirstenYau, Jih DarChan, LukeMcGarvie, SusanTang, LingshanLim, HuiYap, SuhhueyPark, JayNg, Zhan HerrMirza, ShahrukhAng, Yun LinWalls, LukeTeasdale, EllaRoy, ChloePaterson-Brown, SimonCamilleri-Brennan, JulianMclean, KennethD'Souza, Michelle S.Pronin, SavvaHenshall, David EwartTer, Eunice ZulingFouad, DinaMinocha, AshishEnglish, WilliamMorgan, CatrinTownsend, DominicMaciejec, LauraMahdi, ShareefAkpenyi, OnyinyeHall, ElisabethCaydiid, HanaanRob, ZakariaAbbott, TomTorrance, Hew D.Irwin, GarethJohnston, RobinGani, Mohammed AkilGravante, GianpieroRajmohan, ShivanchanMajid, KiranDindyal, ShivaSmith, ChristopherPalliyil, MadanmohanPatel, SanjayNicholson, LukeHarvey, NeilBaillie, KatieShillito, SamKershaw, SuzanneBamford, RebeccaOrton, PeterReunis, ElkeTyler, RobertSoon, Wai CheongJama, Guled M.Dhillon, DharminderPatel, KhyatiNanthakumaran, ShayanthanHeard, RachelChen, Kar YanBarmayehvar, BehradDatta, UttaranKamarajah, Sivesh K.Karandikar, SharadTani, Sobhana IftekharMonaghan, EimearDonnelly, PhilippaWalker, MichaelParakh, JehangirshawBlacker, SarahKaul, AnilParamasivan, ArjunFarag, SamehNessa, AshrafunAwadallah, SalwaLim, JieqiNg, James Chean KhunGash, KatherineKiran, Ravi P.Murray, AliceEtchill, EricDasari, MohiniPuyana, JuanHaddad, NadeemZielinski, MartinChoudhry, AsadCaliman, CelesteBeamon, MieshiaDuane, ThereseNarayanan, RagavanSwaroop, MamtaMyers, JonathanDeal, RebeccaSchadde, ErikHemmila, MarkNapolitano, LenaTo, KathleenMakupe, AlexMusowoya, JosephMaimbo, MayabaVan Der Naald, NielsKumwenda, DaysonReece-Smith, AlexOtten, KarsVerbeek, AnnaPrins, MarloesBaquero Suarez, Alibeth AndresBalmaceda, RubenDeane, ChelseaDijan, EmilioElfiky, MahmoudKoskenvuo, LauraThollot, AuroreLimoges, BernardCapito, CarmenAlexandre, ChallineKotobi, HenriLeroux, JulienRod, JulienPinnagoda, KalithaHenric, NicolasAzzis, OlivierRosello, OlivierFrancois, PoddevinEtienne, SaraBuisson, PhilippeHmila, SophianClegg-Lamptey, Joe-NatImoro, OsmanAbem, Owusu EmmanuelWondoh, PaulPapageorgiou, DimitriosSoulou, VasilikiAsturias, SabrinaPena, LeninKumar, BasantO'Connor, Donal B.Luc, Alberto RealisRusso, Alfio AlessandroRuzzenente, AndreaTaddei, AntonioCona, CamillaBottini, CorradoPascale, GiovanniRotunno, GiuseppeSolaini, LeonardoPascale, Marco MariaNotarnicola, MargheritaCorbellino, MarioSacco, MicheleUbiali, PaoloCautiero, RobertoBocchetti, TommasoMuzio, ElenaGuglielmo, VaniaMorandi, EugenioMao, PatrizioDe Luca, EmiliaNotarnicola, MargheritaMahmoud, FarahZilinskas, JustasStrupas, KestutisKondrotas, PauliusBaltrunas, RobertasKutkevicius, JuozasIgnatavicius, PovilasTan, Choy LingSiaw, Jia YngYam, Sir YoungWilson, LingAziz, Mohamed Rezal AbdulBondin, JohnDiaz Zorrilla, CarminaMajbar, AnassSale, DanjumaAbdullahi, LawalOsagie, OlabisiFaboya, OmolaraFatuga, AdedejiTaiwo, AgboolaNwabuoku, EmekaBliksoen, MarteKhan, Zain AliCoronel, JazminMiranda, CesarVasquez, IdelsoHelguero-Santin, Luis M.Rickard, JenniferMironescu, AurelAdedeji, AdesinaAlqahtani, SalehRath, MaxVan Niekerk, MichaelKoto, Modise ZachariaMatos-Puig, RoelIsraelsson, LeifSchuetz, TobiasYuksek, Mahmut ArifMericliler, MericUlusahin, MehmetWolf, BernhardFairfield, CameronYong, Guo LiangWhitehurst, KatharineWilson, MichaelRedgrave, NatalieMusyoka, Caroluce K.Olivier, JamesLee, KathrynCox, MichaelFarhan-Alanie, Muhamed M. H.Callan, RoryChibuye, ChaliAli, Tebian Hassanein AhmedRekhis, SyrineRommaneh, MunaHalhouli, OdaySam, Zi HaoIsmail, LawaniKalles, VasileiosPata, FrancescoNita, Gabriela ElisaCoccolini, FedericoAnsaloni, LucaPugliesi, Thays BrunelliPardo, GabrielBlanco, RuthCollaborative, GlobalSurg2023-02-212023-02-212018-01-0110.1016/S1473-3099(18)30101-4https://hdl.handle.net/11443/2893http://dx.doi.org/10.1016/S1473-3099(18)30101-4Background Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials. gov, number NCT02662231. Findings Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58.5\%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31.2\%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (1.2\%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12.3\%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 {[}9.4\%] of 7339 patients), middle (549 {[}14.0\%] of 3918 patients), and low (298 {[}23.2\%] of 1282) HDI (p<0.001). The highest SSI incidence in each HDI group was after dirty surgery (102 {[}17.8\%] of 574 patients in high-HDI countries74 {[}31.4\%] of 236 patients in middle-HDI countries72 {[}39.8\%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1.60, 95\% credible interval 1.05-2.37p=0.030). 132 (21.6\%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16.6\%) of 295 patients in high-HDI countries, in 37 (19.8\%) of 187 patients in middle-HDI countries, and in 46 (35.9\%) of 128 patients in low-HDI countries (p< 0.001). Interpretation Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication.Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort studyArticleWOS:000430569700035