THE MICROBIAL PATTERN AND ANTIBIOTIC SUSCEPTIBILITY IN POST-CAESAREAN SECTION WOUND INFECTION IN A TERTIARY CARE HOSPITAL IN BUNDI, RAJASTHAN

Abstract

The third most frequent nosocomial infection is surgical site infection (SSI). Surgical site infections (SSI) account for 38% of all nosocomial infections in surgical patients, according to the CDC's National Nosocomial Infection Surveillance System.(1)They are to blame for the rising expense, morbidity, and death rates associated with surgery. SSI is still a significant issue even in institutions with state-of-the-art equipment and regular preoperative and antibiotic prophylactic measures.(2).

Any infection that develops at the incision or operative site (including drains) within 30 days of the procedure, if no implant is left in place, or within a year, if an implant is left in place, is considered a surgical site infection. The CDC defines three types of surgical site infections: "Organ or Space infection," which affects any part of the body other than the incision that is opened or manipulated during the surgical procedure; "Deep incisional," which affects the layers of muscle and fascia; and "Superficial incisional," which affects the skin and subcutaneous tissue.(3)Bacterial infections are nearly always the cause of surgical site infections. Both exogenous and endogenous sources could be to blame. Bacteria from the patient's skin, mucous membranes, or hollow viscera are examples of endogenous sources.(4). Endogenous organisms can include faecal flora (such as anaerobic bacteria and gramme negative aerobes), although they are mostly aerobic gram-positive cocci (like staphylococci). The operating room environment (including the air), operating room staff, and any equipment, supplies, and tools brought into the sterile field during an operation are examples of exogenous sources of SSI infections. Aerobes, particularly gram-positive organisms like streptococci and staphylococci, make up the majority of exogenous flora.(5). Caesarean delivery is one of the most common procedure performed worldwide. It is a clean contaminated type of surgery. Determinants of infection may be related to the host(such as tobacco use; limited prenatal care; obesity; corticosteroid use; nulliparity; twin gestations; and previous CD) ,intrapartum and operative factors (such as chorioamnionitis; premature rupture of membranes; prolonged rupture of membranes; prolonged labor, particularly prolonged second stage; large incision length; subcutaneous tissue thickness > 3 cm; subcutaneous hematoma; lack of antibiotic prophylaxis), type of procedure (emergency/elective), previous caesarean section, and environment of the operating room, microbe, malnutrition and low socioeconomic status further exacerbate the risk of infection in caesarean sections.(6) Understanding SSI and the variables affecting it with careful pre, inter and post surgical prevention and management of associated risk factors and following stringent infection control practices in the operation room can help to achieve minimal infection rate in patients undergoing caesarean delivery(7).