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. 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. 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 (10·2%) 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 countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [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 1·05-2·37; p=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). 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. DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant.

The authors wish to make the corrections to this paper [1]

Dichotic listening (DL) is a neuropsychological technique for the study of functional laterality. Based on behavioral patient studies, the “structural theory” states that lateralization of the auditory input during DL is allowed by an inhibition of the ipsilateral pathways. We aimed here at extending this theory to provide a neurophysiological basis of verbal DL. We investigated the magnetic responses of the primary auditory cortices elicited by dichotic consonant–vowel syllables. Dichotic stimuli consisted of 2 syllables pairs, a “competing” one composed by syllables with high spectral overlap (/da/ and /ba/) and a “noncompeting” pair (/da/ and /ka/). One of the syllables in each pair was delivered at 2 intensities, whereas the other did not change. A reduced increase of source intensity in response to dichotic pairs at the 2 levels was assumed to indicate pathway inhibition effects. We obtained that the left ipsilateral pathway (i.e., the left ipsilateral signal) was strongly inhibited by the right contralateral one. Conversely, the right ipsilateral pathway did not show an inhibition larger than the left contralateral one. These results extend the notion of auditory functional asymmetries by showing that beyond hemispheric functional specialization there is an asymmetry within the ascending auditory system, which is based on a competition mechanism. The larger the competition between the left and right ear stimuli, the larger are the inhibition effects, which determine the pathway asymmetry. These findings represent as well a neurophysiological basis for the “structural theory” explaining the right ear preference usually found in verbal DL tasks.