Title: Surgical Site Infection in Clean, Clean-Contaminated and Contaminated Cases
Authors: Dr Karan Kumar, Dr S. R. Kulkarni, Dr Gayatri, Dr Sudanshu V. Tripathi, Dr Ajinkya N. Puppal
DOI: https://dx.doi.org/10.18535/jmscr/v4i12.111
Abstract
Objective- To study the incidence, risk factors, most common organisms encountered and its antibiotic sensitivity and resistance in Surgical Site Infection cases of Clean, Clean-Contaminated and Contaminated cases.
Material and Methods- Study was carried out in the Department of General Surgery, from November 2014 to April 2016 on 200 admitted patients who underwent various surgical procedures (clean, clean-contaminated and contaminated cases) and were assessed pre-operatively, intra-operatively and post-operatively. Patients were followed up to 30 days post-operatively. Infected wounds were studied bacteriologically and clinically.
Results- The overall infection rate was 5.50%. Surgical site infection rate was 0.0% in clean surgeries, 4.82% in clean-contaminated surgeries, 23.33% in contaminated surgeries. Surgical site infection rate was higher (9.52%) in emergency surgeries than in elective surgeries (3.65%). The most common isolate was Klebsiella spp. followed by Pseudomonas and E.coli.
Conclusion- Incidence of General Surgical Site Infection is 5.5%. Emergency cases have high infection rate. Longer the duration of surgery more is the Surgical Site Infection rate. Gram -ve bacilli were more common isolates detected. Most of the bacterial isolates were multidrug resistant.
Keywords- Surgical site infection, Klebsiella spp., Pseudomonas aeruginosa, Risk of Surgical site infection.
References
1. Zimlichman E, Henderson D, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA intern Med. 2013 Dec; 173 (22): 2039-2046.
2. Satyanarayana V. et al. Study of Surgical site infections in Abdominal Surgeries. Journal of Clinical and Diagnostic Research. 2011 October; 5(5): 935-9.
3. Mahesh CB, Shivakumar S, Suresh BS, Chidanand SP, Vishwanath Y. A prospective study of SSIs in a teaching hospital. Journal of Clinical and Diagnostic Research 2010 October; 4: 3114-3119.
4. Taylor GD, Kirkland TA, Mckenzie MM, Sutherland B, Wiens RM. The effect of surgical wound infection on post-operative hospital stay. Can J Surg 1995; Apr; 38(2): 149-53.
5. Kamp-Hopman TE, Block HE, Troelstra A, Gigengock-Baars AC, Weersink AK, Vandenbroucke-Grauls CM, et al. Surveillance for hospital acquired infections in surgical wards in a dutch university hospital. Infect Control Hosp Epidemiol 2003 Aug; 24(8): 584-90.
6. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections 1992: a modification of CDC definitions of surgical wound infections. Infect Control HospEpidemiol 1992; 13(10): 606-8.
7. Mangaram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guidelines for prevention of surgical site infection, 1999. Infect Control HospEpidemiol 1999.apr; 20(4):145-175, 247-78.
8. Cruse PJ, Foord R. The epidemiology of wound infection. A 10-year prospective study of 62,939 wounds. SurgClin North Am. 1980 Feb; 60(1): 27-40.
9. Hernandez K, Ramos E, Seas C, Henostroza G, Gotuzzo E. Incidence of and Risk Factors for Surgical‐Site Infections in a Peruvian Hospital. Infect Control HospEpidemiol; May 2005; 26(5). 473-477.
10. Lilani SP, Jangale N, Chowdhary A, Daver GB. Surgical site infection in clean and clean-contaminated cases. Indian J Med Microbiol. 2005 Oct; 23(4): 249-52.
11. Narsinga Rao Bandaru et al. A Prospective study of Post-operative wound infections in a Teaching Hospital of Rural Setup. J ClinDiagn Res 2012 Sep (suppl);6 (7):1266-71.
12. Anvikar AR, Deshmukh AB, Karyakarte RP, DamleAS,Patwardhan NS, Malik AK et al . A one-year prospective study of 3,280 surgical wounds. Indian J Med Microbiol 1999;17(3):129-32.
13. Nwankwo EO, Ibeh IN, Enabulele OI. Incidence and risk factors of surgical site infection in a tertiary health institution in Kano,Northwestern Nigeria. Int J Infect Control 2012;8 (9):1-6.
14. Tripathy BS, Roy N. Post-operative wound sepsis. Indian J Surg 1984; 47 :285-8.
15. Kowli SS, Nayak MH, Mehta AP, Bhalerao RA (1985). Hospital infection. Indian J. Surg.1985; 48: 475-86.
16. Mawalla B, Mshna SE, Chalya PL, MahaluW et al. Predictors of surgical site infection at Bugando Medical Centre. BMC Surgery 2011,1471-2482/11-21.
17. Jepsen OB, Olesen Larsen S, Frolund Thomsen V. Post-operative wound sepsis in general Surgery-I. Material, methods and frequency. II. An assessment of factors influencing the frequency of wound sepsis. III. An evaluation of the post-operative administration of antibiotics. ActaChirScand Suppl. 1969; 396: 73-79, 80-90, 91-97.
18. Rao R, Sumathi S, Anuradha K, Venkatesh D, Krishna, S (2013). Bacteriology of postoperative wound infections. Int J Pharm Biomed Res 2013; 4(2):72-76.
19. Malik S, Gupta A, Singh KP et al. Antibiogram of Aerobic Bacterial Isolates from Post-operative Wound infections at a Tertiary Care Hospital in India. J Infect Dis Antimicrobe Agents 2011; 28:45-51.