UNASSIGNED: To assess and compare the inter-rater agreement of the CDC criteria and the ASEPSIS score in identifying surgical site infections after cesarean section.
UNASSIGNED: Prospective observational study including 110 patients subjected to a cesarean section at our institution. Surgical wounds were managed according to standard care and were photographed on the third, seventh, and thirtieth postoperative day or during any evaluation in case of complications. Three expert surgeons reviewed the prospectively gathered data and photographs and classified each wound using CDC criteria and the ASEPSIS score. The inter-rater agreements of CDC criteria and ASEPSIS score were determined with Krippendorff\'s Alpha with linear weights and compared with a confidence interval approach.
UNASSIGNED: The weighted α coefficient for CDC criteria was 0.587 (95%CI, 0.411-0.763, p < 0.001, \"moderate\" agreement according to Altman\'s interpretation of weighted agreement coefficient), while the weighted α coefficient for the ASEPSIS score was 0.856 (95%CI, 0.733-0.980, p < 0.001, \"very good\" agreement).
UNASSIGNED: ASEPSIS score presents a \"very good\" inter-rater agreement for surgical site infections identification after cesarean, resulting in a more objective method than CDC criteria (\"moderate\" inter-rater agreement). ASEPSIS score could represent an objective tool for managing and monitoring surgical site infections after cesarean section, also by photographic evaluation.

OBJECTIVE: The efficacy of routine antibiotic prophylaxis for prevention of surgical site infection (SSI) after elective inguinal hernia repair with a mesh patch remains uncertain. The authors of a recent Cochrane meta-analysis based on 17 randomized trials were unable to draw a definitive conclusion on this subject. The purpose of this study was to determine the effectiveness of prophylactic antibiotics for prevention of SSI after elective inguinal hernia repair with mesh and the risk factors for SSI.
METHODS: All low-risk patients who underwent elective inguinal hernia repair with mesh at our institution between 2010 and 2015 were enrolled in this study, with the exception of patients with recurrent hernias or immunosuppressive diseases. All patients received a single intravenous (i.v.) injection of cefuroxime (1.5 g) within 2 h prior to surgery at the discretion of the surgeon. SSI was defined using criteria of the Centers for Disease Control and Prevention. The variables which could influence the rate of SSI were analyzed by multivariate analysis to determine the independent risk factors for SSI.
RESULTS: Among the 605 patients who underwent elective inguinal hernia repair with mesh during the study period, 553 were eligible for enrolment in the study. Of these, 331 received a single dose of cefuroxime preoperatively. The overall SSI rate was 5.4 %; 9.4 % of those patients who did not receive preoperative antibiotic prophylaxis developed SSI versus 2.8 % of those who did receive prophylaxis (P = 0.001). All infections were superficial. Factors independently associated with SSI were advanced age, smoking and preoperative stay.
CONCLUSIONS: The incidence of SSI among low-risk patients who did and did not receive preoperative antibiotic prophylaxis after elective inguinal hernia repair with mesh differed significantly, particularly among patients of advanced age, smokers and patients with a prolonged preoperative stay in the hospital.