SURGICAL SITE INFECTION RATES IN ELECTIVE ABDOMINAL SURGERIES: A PROSPECTIVE STUDY AT A TERTIARY CARE HOSPITAL"

Abstract

Background: Surgical site infection (SSI) is the second most common nosocomial infection, significantly contributing to post-operative morbidity, prolonged hospital stays, increased healthcare costs, and diminished patient comfort. Despite advances in surgical ways, sterile practices, and antibiotic use, SSI rates remain high, especially in developing countries. While the rate of SSI has decreased from around 75% a century ago to less than 10% in some regions, its impact continues to be profound. Local data on SSI, particularly in the context of elective abdominal surgeries, is limited in many developing nations. This study aims to address this gap by exploring the incidence, risk factors, and causative pathogens of SSI in elective abdominal surgeries.

Objectives

1. To determine the incidence of surgical site infection in elective abdominal


2. To identify the predisposing risk factors for the development of SSI in elective abdominal surgeries.


3. To identify the common pathogens causing SSI in elective abdominal surgeries and their antibiotic sensitivity.

Methods

This prospective observational study was conducted at the Department of General Surgery, Rajarajeswari Medical College and Hospital, from January to June 2024. An aggegate of 100 patients undergoing elective abdominal surgeries were included. Sample size was calculated using Yamane equation. Inclusion criteria comprised patients of 12 years and older who developed SSI within 30 days post-operatively.

Exclusion criteria included infections limited to drain sites and laparoscopic procedures. Descriptive and inferential statistics were used for data analysis, with ap- value < 0.05 considered statistically significant.

Results

The overall SSI rate was 6%, higher than that reported in Western countries. The highest SSI rate was observed in clean-contaminated wounds (19.1%) compared to clean wounds (2.5%, p=0.02). SSI rates increased with age, though not significantly (from0%in<40yearsto11.1%in>61years, p=0.3). Females had a higher SSI rate (10.7%) than males (4.2%), though this difference was not statistically significant.

Identified risk factors included diabetes mellitus (25%), hypertension (23.1%), and anemia (16.7%), with diabetes mellitus being the only independent risk factor (p=0.009). Extended pre-operative hospitalization (>5 days) and longer surgery durations (>1 hour) were also associated with higher SSI rates (p=0.03, p=0.04).

Bacteriological analysis identified Escherichia coli and Staphylococcus aureus as the most common pathogens, with resistance to common antibiotics but sensitivity to linezolid, imipenem, meropenem, and amikacin.

Conclusion:

The study highlights the relatively high incidence of SSI in elective abdominal surgeries in a developing country setting, with diabetes mellitus identified as a key risk factor. The most common pathogens identified were E. coli and S. aureus, which exhibited resistance to many common antibiotics. These findings emphasize the need for tailored strategies to prevent and manage SSI, including improved pre-operative care, better antibiotic stewardship, and more localized data to inform clinical practices.