infection control and hospital epidemiology march 2007, vol. 28, no. 3 original article Prospective Surveillance for Surgical Site Infection in St. Petersburg, Russian Federation Samuel M. Brown, MD; Sergey R. Eremin, MD, PhD; Sergey A. Shlyapnikov, MD, PhD; Elena A. Petrova, MD; Ludmila V. Shirokova, MD; Donald Goldmann, MD; Edward J. O’Rourke, MD objective. To assess the risk-adjusted incidence and predictors of surgical site infections (SSIs). design. Prospective, multicenter, observational cohort study. setting. Seven surgical departments at 3 urban academic hospitals in St. Petersburg, Russian Federation. patients. All patients had surgery performed between January 15 and May 12, 2000. A total of 1,453 surgical procedures were followed up. Medical records were unavailable for less than 3% of all patients; patients were not excluded for any other reason. The mean patient age was 49.3 years, 61% were female, and 34% had an American Society of Anesthesiologists physical status classification (hereafter, “ASA classification”) of at least 3. Surgery for 45% of the patients was emergent. results. In all, 138 patients (9.5%) developed SSI, for a rate that was approximately 3.5 times the risk-stratified rates in the United States. Male sex (odds ratio [OR], 1.54), ASA classifications of 3 (OR, 3.7) or 4 (OR, 5.0), longer duration of surgery (OR, 2.2), and wound classes of 3 (OR, 5.5) or 4 (OR, 14.3) were associated with increased SSI risk in multivariate analysis. Endoscopic surgery was associated with a lower risk of SSI (OR, 0.23). Antibiotic prophylaxis was used in 0%-33% of operations, and 69% of uninfected patients received antibiotics after the operation. conclusions. The SSI rates are significantly higher than previously reported. Although this finding may be attributable to inadequate antibiotic prophylaxis, local infection control and surgical practices may also be contributors. Use of antibiotic prophylaxis should be encouraged and the effect of local practices further investigated. Active SSI surveillance should be expanded to other parts of the Russian Federation. Infect Control Hosp Epidemiol 2007; 28:319-325 From the Davis Center for Russian Studies, Harvard University, Cambridge (S.M.B.), and the Department of Medicine, Massachusetts General Hospital (S.M.B.), the Department of Infectious Diseases, Children’s Hospital (D.G.), and the Department of Infectious Diseases, Harvard Medical School (E.J.O.), Boston, Massachusetts; and the Department of Epidemiology, Mechnikov Medical Academy (S.R.E.), the Department of Surgery, Clinical Railroad Hospital (S.A.S.), the Department of Epidemiology, 26th Municipal Hospital (E.A.P.), and the Department of Epidemiology, 4th Municipal Hospital (L.V.S.), St. Petersburg, Russian Federation. (Current affiliation: Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University Of Utah Health Sciences Center, Salt Lake City [S.M.B.].) Received October 27, 2005; accepted February 20, 2006; electronically published February 20, 2007.  2007 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2007/2803-0010$15.00. DOI: 10.1086/509849 Surgical site infections (SSIs) occur commonly and are as- sociated with substantial economic burden, considerable ad- ditional morbidity, and occasional mortality. 1 Although the pre- cise mechanisms remain unclear, several studies suggest a benefit of reporting surveillance results to relevant clinicians. 2- 4 By various estimates, surveillance and reporting systems can decrease rates of SSIs by 30%-50%. 2,5 For this reason, as well as to determine priorities for funding and prevention efforts, it is essential to have accurate, risk-adjusted data on the in- cidence of SSIs and the use of established preventive mea- sures. 6,7 There is broad-based international support for meth- odologically rigorous, consistent, risk-stratified analysis and reporting of surgical infection rates. 6-10 Most published ap- proaches use the methods (often with minor modifications) of the National Nosocomial Infection Surveillance (NNIS) sys- tem of the Centers for Disease Control and Prevention. 11-13 Several European countries, as well as an increasing num- ber of countries outside North America and Europe, have reported surveillance results. 14-25 The Russian Federation re- mains underrepresented in this literature. Political, cultural, and economic factors have prevented the gathering of ac- curate, reliable data on the incidence and significance of SSIs. Each reported SSI is officially investigated and may result in punishments and fines. Surveillance in general, both internal and external to the hospital, is passive. Official data from the Sanitary-Epidemiologic Service underreport SSIs, with rates generally less than 0.5%. In 1999 in St. Petersburg (a me- tropolis of 5 million people), 47,860 operative procedures