Surgical site infections after hysterectomy among HIV-infected women in the HAART era: a single institution's experience from 1999–2012

• Published in: American journal of obstetrics and gynecology 2014-02, Vol.210 (2), p.117.e1-117.e7
• Main Authors: Coleman, Jenell Sheree, MD, MPH, Green, Isabel, MD, Scheib, Stacey, MD, Sewell, Catherine, MD, MPH, Lee, Judy Mon-Hwa, MD, MBA, Anderson, Jean, MD
• Format: Article
• Language: English
• Subjects: Adult; Antiretroviral Therapy, Highly Active; CD4 count; Female; HIV Infections - complications; HIV Infections - drug therapy; human immunodeficiency virus; Humans; hysterectomy; Hysterectomy - methods; Middle Aged; Obstetrics and Gynecology; preoperative albumin; Retrospective Studies; Risk Factors; Serum Albumin - analysis; surgical site infection; Surgical Wound Infection - etiology
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2013.08.037

Objective We sought to determine risk factors associated with surgical site infection (SSI) among a cohort of human immunodeficiency virus (HIV)-infected women undergoing hysterectomy during the era of highly active antiretroviral therapy. Study Design This is a retrospective study of HIV-infected women who underwent a hysterectomy for benign indications at a tertiary care center. Electronic medical records were reviewed from January 1999 through December 2012. SSI was defined using Centers for Disease Control and Prevention criteria. Results There were 77 HIV-infected women who underwent a hysterectomy: 47 (61%) were abdominal; 16 (21%) were laparoscopic or robot-assisted; and 14 (18%) were vaginal. Acquired immune deficiency syndrome was diagnosed in 58% of patients, and 75% of patients self-reported use of highly active antiretroviral therapy at the time of surgery. There were 17 (22%) SSIs; 5 (29%) superficial incisional wound infections, 3 (18%) vaginal cuff cellulitis, and 9 (53%) pelvic abscesses were diagnosed. After multivariable logistic regression, preoperative albumin level (adjusted odds ratio [aOR], 0.14; 95% confidence interval [CI], 0.02–0.86) and minimally invasive hysterectomy (aOR, 0.16; 95% CI, 0.03–0.84) were associated with decreased SSI. Preoperative absolute CD4 count was not associated with SSI (aOR, 0.99; 95% CI, 0.99–1). Conclusion Low preoperative serum albumin levels and abdominal hysterectomy are associated with increased risk of SSIs in HIV-infected women.