Patel H , Khoury H , Girgenti D , Welner S , Yu H , 2017. Burden of surgical site infections associated with select spine operations and involvement of Staphylococcus aureus. Surg Infect (Larchmt) 18: 461–473.
Shaffer WO , Baisden JL , Fernand R , Matz PG , 2013. North American Spine Society, an evidence-based clinical guideline for antibiotic prophylaxis in spine surgery. Spine J Off J North Am Spine Soc 13: 1387–1392.
Fiani B , Cathel A , Sarhadi KJ , Cohen J , Siddiqi J , 2020. Neurosurgical post-operative wound infections: a retrospective study on surgical site infections for quality improvement. Int Wound J 17: 1039–1046.
Kobayashi K et al., 2020. Trends in reoperation for surgical site infection after spinal surgery with instrumentation in a multicenter study. Spine 45: 1459–1466.
Lazary A , Klemencsics I , Szoverfi Z , Kiss L , Biczo A , Szita J , Varga PP , 2020. Global treatment outcome after surgical site infection in elective degenerative lumbar spinal operations. Surg Infect (Larchmt) 22: 193–199.
Garcia DR et al., 2020. Analysis of growth and biofilm formation of bacterial pathogens on frequently used spinal implant materials. Spine Deform 8: 351–359.
Lazennec J-Y , Fourniols E , Lenoir T , Aubry A , Pissonnier M-L , Issartel B , Rousseau M-A , 2011. French Spine Surgery Society, Infections in the operated spine: update on risk management and therapeutic strategies. Orthop Traumatol Surg Res 97: 107–116.
2017 Saint-Maurice : Santé Publique France, Surveillance des Infections du site Opératoire dans les établissements de santé Français. Résultats 2015.
Ferry T et al., 2019. The CRIOAc healthcare network in France: a nationwide health ministry program to improve the management of bone and joint infection. Orthop Traumatol Surg Res 105: 185–190.
Bouyer B , Arvieu R , Gerlinger MP , Watier L , Kassis N , Nerome S , Diop A , Mainardi JL , Durieux P , Guigui P , 2020. Individual decontamination measures reduce by two the incidence of surgical site infections in spinal surgery. Orthop Traumatol Surg Res 106: 1175–1181.
Barker FG , 2002. Efficacy of prophylactic antibiotic therapy in spinal surgery: a meta-analysis. Neurosurgery 51: 391–400.
Horan TC , Gaynes RP , Martone WJ , Jarvis WR , Emori TG , 1992. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13: 606–608.
Astagneau P et al., 2009. Reducing surgical site infection incidence through a network: results from the French ISO-RAISIN surveillance system. J Hosp Infect 72: 127–134.
Le Réseau d’alerte, d’investigation et de surveillance des infections nosocomiales (Raisin) , Surveillance des infections du site opératoire dans les établissements de santé français. Résultats 2016. Saint-Maurice: Santé publique France, février 2018, 223 p. (n.d.). Available at: http://invs.santepubliquefrance.fr/Publications-et-outils/Rapports-et-syntheses/Maladies-infectieuses/2018/Surveillance-des-infections-du-site-operatoire-dans-les-etablissements-de-sante-francais. Accessed May 3, 2018.
Lonjon G , Dauzac C , Fourniols E , Guigui P , Bonnomet F , Bonnevialle P , French Orthopaedic Surgery Traumatology Society , 2012. Early surgical site infections in adult spinal trauma: a prospective, multicentre study of infection rates and risk factors. Orthop Traumatol Surg Res 98: 788–794.
Abdul-Jabbar A et al., 2013. Surgical site infections in spine surgery: identification of microbiologic and surgical characteristics in 239 cases. Spine 38: 1425–1431.
Maruo K , Berven SH , 2014. Outcome and treatment of postoperative spine surgical site infections: predictors of treatment success and failure. J. Orthop. Sci. Off. J. Jpn. Orthop. Assoc. 19: 398–404.
Chen S-H , Lee C-H , Huang K-C , Hsieh P-H , Tsai S-Y , 2015. Postoperative wound infection after posterior spinal instrumentation: analysis of long-term treatment outcomes. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 24: 561–570.
Durkin MJ , Dicks KV , Baker AW , Moehring RW , Chen LF , Sexton DJ , Lewis SS , Anderson DJ , 2015. Postoperative infection in spine surgery: does the month matter? J Neurosurg Spine 23: 128–134.
Liu S , Qi Q , Chen Z , Liu N , Guo Z , Sun C , Li W , Zeng Y , Liu Z , 2017. Polymicrobial and monomicrobial infections after spinal surgery: a retrospective study to determine which infection is more severe. Asian Spine J 11: 427–436.
Adogwa O , Fatemi P , Perez E , Moreno J , Gazcon GC , Gokaslan ZL , Cheng J , Gottfried O , Bagley CA , 2014. Negative pressure wound therapy reduces incidence of postoperative wound infection and dehiscence after long-segment thoracolumbar spinal fusion: a single institutional experience. Spine J Off J North Am Spine Soc 14: 2911–2917.
Chaichana KL , Bydon M , Santiago-Dieppa DR , Hwang L , McLoughlin G , Sciubba DM , Wolinsky J-P , Bydon A , Gokaslan ZL , Witham T , 2014. Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases. J Neurosurg Spine 20: 45–52.
Ghobrial GM et al., 2014. Intraoperative vancomycin use in spinal surgery: single institution experience and microbial trends. Spine 39: 550–555.
Kabirian N et al., Growing Spine Study Group , 2014. Deep surgical site infection following 2344 growing-rod procedures for early-onset scoliosis: risk factors and clinical consequences. J Bone Joint Surg Am 96: e128.
Mackenzie WGS et al., 2013. Surgical site infection following spinal instrumentation for scoliosis: a multicenter analysis of rates, risk factors, and pathogens. J Bone Joint Surg Am 95: 800–806.
Ogihara S et al., 2015. Prospective multicenter surveillance and risk factor analysis of deep surgical site infection after posterior thoracic and/or lumbar spinal surgery in adults. J Orthop Sci Off J Jpn Orthop Assoc 20: 71–77.
Rao SB et al., 2011. Risk factors for surgical site infections following spinal fusion procedures: a case-control study. Clin Infect Dis Off Publ Infect Dis Soc Am 53: 686–692.
Schimmel JJP , Horsting PP , de Kleuver M , Wonders G , van Limbeek J , 2010. Risk factors for deep surgical site infections after spinal fusion. Eur Spine J 19: 1711–1719.
McClelland S , Takemoto RC , Lonner BS , Andres TM , Park JJ , Ricart-Hoffiz PA , Bendo JA , Goldstein JA , Spivak JM , Errico TJ , 2016. Analysis of postoperative thoracolumbar spine infections in a prospective randomized controlled trial using the centers for disease control surgical site infection criteria. Int J Spine Surg 10: 14.
Baxi SM , Robinson ML , Grill MF , Schwartz BS , Doernberg SB , Liu C , 2016. Clinical characteristics and outcomes among individuals with spinal implant infections: a descriptive study. Open Forum Infect Dis 3: ofw177.
Dapunt U , Bürkle C , Günther F , Pepke W , Hemmer S , Akbar M , 2017. Surgical site infections following instrumented stabilization of the spine. Ther Clin Risk Manag 13: 1239–1245.
Adogwa O , Elsamadicy AA , Sergesketter A , Vuong VD , Mehta AI , Vasquez RA , Cheng J , Bagley CA , Karikari IO , 2017. Prophylactic use of intraoperative vancomycin powder and postoperative infection: an analysis of microbiological patterns in 1200 consecutive surgical cases. J Neurosurg Spine 27: 328–334.
Molinari RW , Khera OA , Molinari WJ , 2012. Prophylactic intraoperative powdered vancomycin and postoperative deep spinal wound infection: 1,512 consecutive surgical cases over a 6-year period. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 21: 476–482.
Cahill PJ , Warnick DE , Lee MJ , Gaughan J , Vogel LE , Hammerberg KW , Sturm PF , 2010. Infection after spinal fusion for pediatric spinal deformity: thirty years of experience at a single institution. Spine 35: 1211–1217.
Salsgiver E , Crotty J , LaRussa SJ , Bainton NM , Matsumoto H , Demmer RT , Thumm B , Vitale MG , Saiman L , 2017. Surgical site infections following spine surgery for non-idiopathic scoliosis. J Pediatr Orthop 37: 476–483.
National Healthcare Safety Network, Centers for Disease Control and Prevention , Surgical site infection (SSI) event.pdf, (n.d.). Available at: https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Accessed April 10, 2018.
Rubinstein E , Findler G , Amit P , Shaked I , 1994. Perioperative prophylactic cephazolin in spinal surgery. A double-blind placebo-controlled trial. J Bone Joint Surg Br 76: 99–102.
Horan MP , Williams BA , Stuart Mackenzie WG , Matsumoto H , Covington L , Saiman LR , Roye D , Vitale MG , 2011. Can infection following scoliosis instrumentation surgery be a never event? Dramatic reduction in infection rates at one institution after implementation of a multimodal prevention protocol, in: 2011.
Matsumoto H , Simhon ME , Campbell ML , Vitale MG , Larson EL , 2020. Risk factors associated with surgical site infection in pediatric patients undergoing spinal deformity surgery: a systematic review and meta-analysis. JBJS Rev 8: e0163.
Olsen MA , Nepple JJ , Riew KD , Lenke LG , Bridwell KH , Mayfield J , Fraser VJ , 2008. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am 90: 62–69.
Chen S , Anderson MV , Cheng WK , Wongworawat MD , 2009. Diabetes associated with increased surgical site infections in spinal arthrodesis. Clin Orthop Relat Res 467: 1670–1673.
Bohl DD , Shen MR , Mayo BC , Massel DH , Long WW , Modi KD , Basques BA , Singh K , 2016. Malnutrition predicts infectious and wound complications following posterior lumbar spinal fusion. Spine 41: 1693–1699.
Blam OG , Vaccaro AR , Vanichkachorn JS , Albert TJ , Hilibrand AS , Minnich JM , Murphey SA , 2003. Risk factors for surgical site infection in the patient with spinal injury. Spine 28: 1475–1480.
Abstract : Low segment spinal surgery are associated with gram-negative Surgical Site Infections (SSI) (IDWeek 2013), (n.d.). Available at: https://idsa.confex.com/idsa/2013/webprogram/Paper41063.html. Accessed April 17, 2018.
Haleem A , Chiang H-Y , Vodela R , Behan A , Pottinger JM , Smucker J , Greenlee JD , Clark C , Herwaldt LA , 2016. Risk factors for surgical site infections following adult spine operations. Infect Control Hosp Epidemiol 37: 1458–1467.
Daigre J-L , Atallah A , Boissin J-L , Jean-Baptiste G , Kangambega P , Chevalier H , Balkau B , Smadja D , Inamo J , 2012. The prevalence of overweight and obesity, and distribution of waist circumference, in adults and children in the French Overseas Territories: the PODIUM survey. Diabetes Metab 38: 404–411.
Past two years | Past Year | Past 30 Days | |
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Abstract Views | 576 | 261 | 24 |
Full Text Views | 45 | 36 | 1 |
PDF Downloads | 69 | 57 | 2 |
To date, no study has described the microbiological profile of surgical site infections (SSIs) after spine surgery in a tropical environment. The main objective of this study is to describe the microbiology and the risk factors of SSI after spinal surgery in a tropical climate. Our hypothesis is that the microbiology of SSIs in tropical areas is different to what is mainly described in temperate countries. As a consequence, the recommendation for antibiotic prophylaxis administered in the operative room, which mainly relays on the literature, might not be adequate in such countries. We included 323 consecutive patients who underwent a spinal intervention between 2017 and 2019, with a 2-year minimum follow-up. Objective ISO criteria were established in accordance with the criteria accepted by the Center of Disease Control in Atlanta. The identification of risk factors for SSI was carried out by uni- and multivariate analysis with a significance threshold of P < 0.05. The incidence of SSI was 7.7%. A total of 54.8% were in favor of a predominantly digestive origin of germs with an average of 1.68 bacteria found by ISO. Inadequate antibiotic prophylaxis was found in 54.8%. Age and body mass index were found to be independent risk factors for SSI. We report here an unusual microbiological profile of SSI with a predominance of gram-negative bacteria and a low proportion of Staphylococcus aureus and Staphylococcus epidermidis.
Authors’ addresses: Mathieu Severyns, Orthopaedic and Traumatologic Department, CHU Martinique, Fort-de-France, France, and Pprime Institute, University of Poitiers, Poitiers, France, E-mail: mathieu.severyns@hotmail.fr. François-Xavier Hostalrich and Abdelkrim Benchikh El-Fegoun, Orthopaedic and Traumatologic Department, CHU Martinique, Fort-de-France, France, E-mails: francois-xavier.hostalrich@chu-martinique.com and abdelkrim.bechikh-el-fegoun@chu-martinique.fr. Laure Flurin, Divisions of Clinical Microbiology and Infectious Diseases, Mayo Clinic, Rochester, MN, E-mail: laure.flurin@gmail.com. Tanguy Vendeuvre and Arnaud Germaneau, Pprime Institute, University of Poitiers, Poitiers, France, E-mails: tanguy.vendeuvre@chu-poitiers.fr and arnaud.germaneau@univ-poitiers.fr. Jean-Marie Turmel and André Cabié, Infectious Diseases Department, CHU Martinique, Fort-de-France, France, E-mails: jean-marie.turmel@chu-martinique.fr and andre.cabie@chu-martinique.fr.
Patel H , Khoury H , Girgenti D , Welner S , Yu H , 2017. Burden of surgical site infections associated with select spine operations and involvement of Staphylococcus aureus. Surg Infect (Larchmt) 18: 461–473.
Shaffer WO , Baisden JL , Fernand R , Matz PG , 2013. North American Spine Society, an evidence-based clinical guideline for antibiotic prophylaxis in spine surgery. Spine J Off J North Am Spine Soc 13: 1387–1392.
Fiani B , Cathel A , Sarhadi KJ , Cohen J , Siddiqi J , 2020. Neurosurgical post-operative wound infections: a retrospective study on surgical site infections for quality improvement. Int Wound J 17: 1039–1046.
Kobayashi K et al., 2020. Trends in reoperation for surgical site infection after spinal surgery with instrumentation in a multicenter study. Spine 45: 1459–1466.
Lazary A , Klemencsics I , Szoverfi Z , Kiss L , Biczo A , Szita J , Varga PP , 2020. Global treatment outcome after surgical site infection in elective degenerative lumbar spinal operations. Surg Infect (Larchmt) 22: 193–199.
Garcia DR et al., 2020. Analysis of growth and biofilm formation of bacterial pathogens on frequently used spinal implant materials. Spine Deform 8: 351–359.
Lazennec J-Y , Fourniols E , Lenoir T , Aubry A , Pissonnier M-L , Issartel B , Rousseau M-A , 2011. French Spine Surgery Society, Infections in the operated spine: update on risk management and therapeutic strategies. Orthop Traumatol Surg Res 97: 107–116.
2017 Saint-Maurice : Santé Publique France, Surveillance des Infections du site Opératoire dans les établissements de santé Français. Résultats 2015.
Ferry T et al., 2019. The CRIOAc healthcare network in France: a nationwide health ministry program to improve the management of bone and joint infection. Orthop Traumatol Surg Res 105: 185–190.
Bouyer B , Arvieu R , Gerlinger MP , Watier L , Kassis N , Nerome S , Diop A , Mainardi JL , Durieux P , Guigui P , 2020. Individual decontamination measures reduce by two the incidence of surgical site infections in spinal surgery. Orthop Traumatol Surg Res 106: 1175–1181.
Barker FG , 2002. Efficacy of prophylactic antibiotic therapy in spinal surgery: a meta-analysis. Neurosurgery 51: 391–400.
Horan TC , Gaynes RP , Martone WJ , Jarvis WR , Emori TG , 1992. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13: 606–608.
Astagneau P et al., 2009. Reducing surgical site infection incidence through a network: results from the French ISO-RAISIN surveillance system. J Hosp Infect 72: 127–134.
Le Réseau d’alerte, d’investigation et de surveillance des infections nosocomiales (Raisin) , Surveillance des infections du site opératoire dans les établissements de santé français. Résultats 2016. Saint-Maurice: Santé publique France, février 2018, 223 p. (n.d.). Available at: http://invs.santepubliquefrance.fr/Publications-et-outils/Rapports-et-syntheses/Maladies-infectieuses/2018/Surveillance-des-infections-du-site-operatoire-dans-les-etablissements-de-sante-francais. Accessed May 3, 2018.
Lonjon G , Dauzac C , Fourniols E , Guigui P , Bonnomet F , Bonnevialle P , French Orthopaedic Surgery Traumatology Society , 2012. Early surgical site infections in adult spinal trauma: a prospective, multicentre study of infection rates and risk factors. Orthop Traumatol Surg Res 98: 788–794.
Abdul-Jabbar A et al., 2013. Surgical site infections in spine surgery: identification of microbiologic and surgical characteristics in 239 cases. Spine 38: 1425–1431.
Maruo K , Berven SH , 2014. Outcome and treatment of postoperative spine surgical site infections: predictors of treatment success and failure. J. Orthop. Sci. Off. J. Jpn. Orthop. Assoc. 19: 398–404.
Chen S-H , Lee C-H , Huang K-C , Hsieh P-H , Tsai S-Y , 2015. Postoperative wound infection after posterior spinal instrumentation: analysis of long-term treatment outcomes. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 24: 561–570.
Durkin MJ , Dicks KV , Baker AW , Moehring RW , Chen LF , Sexton DJ , Lewis SS , Anderson DJ , 2015. Postoperative infection in spine surgery: does the month matter? J Neurosurg Spine 23: 128–134.
Liu S , Qi Q , Chen Z , Liu N , Guo Z , Sun C , Li W , Zeng Y , Liu Z , 2017. Polymicrobial and monomicrobial infections after spinal surgery: a retrospective study to determine which infection is more severe. Asian Spine J 11: 427–436.
Adogwa O , Fatemi P , Perez E , Moreno J , Gazcon GC , Gokaslan ZL , Cheng J , Gottfried O , Bagley CA , 2014. Negative pressure wound therapy reduces incidence of postoperative wound infection and dehiscence after long-segment thoracolumbar spinal fusion: a single institutional experience. Spine J Off J North Am Spine Soc 14: 2911–2917.
Chaichana KL , Bydon M , Santiago-Dieppa DR , Hwang L , McLoughlin G , Sciubba DM , Wolinsky J-P , Bydon A , Gokaslan ZL , Witham T , 2014. Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases. J Neurosurg Spine 20: 45–52.
Ghobrial GM et al., 2014. Intraoperative vancomycin use in spinal surgery: single institution experience and microbial trends. Spine 39: 550–555.
Kabirian N et al., Growing Spine Study Group , 2014. Deep surgical site infection following 2344 growing-rod procedures for early-onset scoliosis: risk factors and clinical consequences. J Bone Joint Surg Am 96: e128.
Mackenzie WGS et al., 2013. Surgical site infection following spinal instrumentation for scoliosis: a multicenter analysis of rates, risk factors, and pathogens. J Bone Joint Surg Am 95: 800–806.
Ogihara S et al., 2015. Prospective multicenter surveillance and risk factor analysis of deep surgical site infection after posterior thoracic and/or lumbar spinal surgery in adults. J Orthop Sci Off J Jpn Orthop Assoc 20: 71–77.
Rao SB et al., 2011. Risk factors for surgical site infections following spinal fusion procedures: a case-control study. Clin Infect Dis Off Publ Infect Dis Soc Am 53: 686–692.
Schimmel JJP , Horsting PP , de Kleuver M , Wonders G , van Limbeek J , 2010. Risk factors for deep surgical site infections after spinal fusion. Eur Spine J 19: 1711–1719.
McClelland S , Takemoto RC , Lonner BS , Andres TM , Park JJ , Ricart-Hoffiz PA , Bendo JA , Goldstein JA , Spivak JM , Errico TJ , 2016. Analysis of postoperative thoracolumbar spine infections in a prospective randomized controlled trial using the centers for disease control surgical site infection criteria. Int J Spine Surg 10: 14.
Baxi SM , Robinson ML , Grill MF , Schwartz BS , Doernberg SB , Liu C , 2016. Clinical characteristics and outcomes among individuals with spinal implant infections: a descriptive study. Open Forum Infect Dis 3: ofw177.
Dapunt U , Bürkle C , Günther F , Pepke W , Hemmer S , Akbar M , 2017. Surgical site infections following instrumented stabilization of the spine. Ther Clin Risk Manag 13: 1239–1245.
Adogwa O , Elsamadicy AA , Sergesketter A , Vuong VD , Mehta AI , Vasquez RA , Cheng J , Bagley CA , Karikari IO , 2017. Prophylactic use of intraoperative vancomycin powder and postoperative infection: an analysis of microbiological patterns in 1200 consecutive surgical cases. J Neurosurg Spine 27: 328–334.
Molinari RW , Khera OA , Molinari WJ , 2012. Prophylactic intraoperative powdered vancomycin and postoperative deep spinal wound infection: 1,512 consecutive surgical cases over a 6-year period. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 21: 476–482.
Cahill PJ , Warnick DE , Lee MJ , Gaughan J , Vogel LE , Hammerberg KW , Sturm PF , 2010. Infection after spinal fusion for pediatric spinal deformity: thirty years of experience at a single institution. Spine 35: 1211–1217.
Salsgiver E , Crotty J , LaRussa SJ , Bainton NM , Matsumoto H , Demmer RT , Thumm B , Vitale MG , Saiman L , 2017. Surgical site infections following spine surgery for non-idiopathic scoliosis. J Pediatr Orthop 37: 476–483.
National Healthcare Safety Network, Centers for Disease Control and Prevention , Surgical site infection (SSI) event.pdf, (n.d.). Available at: https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Accessed April 10, 2018.
Rubinstein E , Findler G , Amit P , Shaked I , 1994. Perioperative prophylactic cephazolin in spinal surgery. A double-blind placebo-controlled trial. J Bone Joint Surg Br 76: 99–102.
Horan MP , Williams BA , Stuart Mackenzie WG , Matsumoto H , Covington L , Saiman LR , Roye D , Vitale MG , 2011. Can infection following scoliosis instrumentation surgery be a never event? Dramatic reduction in infection rates at one institution after implementation of a multimodal prevention protocol, in: 2011.
Matsumoto H , Simhon ME , Campbell ML , Vitale MG , Larson EL , 2020. Risk factors associated with surgical site infection in pediatric patients undergoing spinal deformity surgery: a systematic review and meta-analysis. JBJS Rev 8: e0163.
Olsen MA , Nepple JJ , Riew KD , Lenke LG , Bridwell KH , Mayfield J , Fraser VJ , 2008. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am 90: 62–69.
Chen S , Anderson MV , Cheng WK , Wongworawat MD , 2009. Diabetes associated with increased surgical site infections in spinal arthrodesis. Clin Orthop Relat Res 467: 1670–1673.
Bohl DD , Shen MR , Mayo BC , Massel DH , Long WW , Modi KD , Basques BA , Singh K , 2016. Malnutrition predicts infectious and wound complications following posterior lumbar spinal fusion. Spine 41: 1693–1699.
Blam OG , Vaccaro AR , Vanichkachorn JS , Albert TJ , Hilibrand AS , Minnich JM , Murphey SA , 2003. Risk factors for surgical site infection in the patient with spinal injury. Spine 28: 1475–1480.
Abstract : Low segment spinal surgery are associated with gram-negative Surgical Site Infections (SSI) (IDWeek 2013), (n.d.). Available at: https://idsa.confex.com/idsa/2013/webprogram/Paper41063.html. Accessed April 17, 2018.
Haleem A , Chiang H-Y , Vodela R , Behan A , Pottinger JM , Smucker J , Greenlee JD , Clark C , Herwaldt LA , 2016. Risk factors for surgical site infections following adult spine operations. Infect Control Hosp Epidemiol 37: 1458–1467.
Daigre J-L , Atallah A , Boissin J-L , Jean-Baptiste G , Kangambega P , Chevalier H , Balkau B , Smadja D , Inamo J , 2012. The prevalence of overweight and obesity, and distribution of waist circumference, in adults and children in the French Overseas Territories: the PODIUM survey. Diabetes Metab 38: 404–411.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 576 | 261 | 24 |
Full Text Views | 45 | 36 | 1 |
PDF Downloads | 69 | 57 | 2 |