PREVALENCE OF SURGICAL SITE INFECTION AND PATTERN OF ANTIBIOTIC USE IN A TERTIARY CARE HOSPITAL

Main Article Content

Reema Ghani
Jawad Alam Khattak
Shumaila Sikander
Mir Wais

Keywords

Antibiotic, Surgical Site Infection, Resistance

Abstract

Objective: To determine the prevalence of surgical site infection and to find out the most frequent pathogen in cases operated in casualty of LRH Peshawar, Pakistan and to which antibiotics isolated pathogens are sensitive.


Study Design. A descriptive and cross sectional study


Place and Duration: This study was conducted at surgical C unit of LRH Peshawar. A descriptive hospital record based study was carried out starting from1st November 2018 to 30th November 2019.


Methods: Total 125 patients of both genders aged between 10-80 years were included in this study. Patients detailed demographics age, sex and body mass index were recorded after taking written consent.  Patients who suffered from  peritonitis secondary to traumatic bowel perforation or perforated viscus and later on developed surgical site infection after being operated in casuality were included.while those on elective list were excluded.


Complete data was analyzed by SPSS 24.0 version.


Results: Mean age of the patients were 38.96 ±8.14 years with mean BMI 28.96 ±4.14 kg/m2 . 70 (56%) patients were males and 55 (44%) were females. Out of 125 presented cases infection rate was observed among 18 (14.4) patients those were affected with surgical site. Causative organism isolated was found escherichia coli. Commonly prescribed antibiotics were Cefoperazone Sulbactam which was followed by the ceftriaxone and metronidazole during the operative time.


Conclusion: We concluded in this study that surgical site infection was found 14.4 % and can be cured by early medication. Cefoperazone Sulbactam was the most commonly used drug. The most commonly pathogens isolated from patients with postoperative SSIs was found to be Escherichia coli (35.2%) followed by Klebsiella pneumonia (28%).

Abstract 188 | PDF Downloads 79

References

1. Alemkere G. Antibiotic usage in surgical prophylaxis: A prospective observational study in the surgical ward of Nekemte referral hospital. PLoS One. 2018;13(9):e0203523.
doi:10.1371/journal.pone.0203523
2. Allegranzi B, Nejad SB, Combescure C, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377(9761):228–241. doi:10.1016/S0140-6736(10)61458-4
3. Smith MA, Dahlen NR, Bruemmer A, Davis S, Heishman C. Clinical practice guideline surgical site infection prevention. Orthopaedic Nursing. 2013;32(5):242–248.
doi:10.1097/NOR.0b013e3182a39c6b
4. Negi V, Pal S, Juyal D, Sharma MK, Sharma N. Bacteriological profile of surgical site infections and their antibiogram: a study from resource constrained rural setting of Uttarakhand State, India. J Clin Diagn Res. 2015;9:DC17-DC20.
5. Jisha H. Timing of prophylactic antibiotic administration in elective surgical patients at Jimma University Teaching Hospital: South West Ethiopia. J Anesth Clin Res. 2016;7:1-7
6. Tan JA, Naik VN, Lingard L. Exploring obstacles to proper timing of prophylactic antibiotics for surgical site infections. Qual Saf Health Care. 2006;15:32-38.
7. Shah JN, Maharjan SB, Piya R, et al. Need of improvement in timing of prophylactic antibiotic in elective surgery. JNMA J Nepal Med Assoc. 2010;49:204-208.
8. Meeks DW, Lally KP, Carrick MM, et al. Compliance with guidelines to prevent surgical site infections: as simple as 1-2-3? Am J Surg. 2011;20:76-83.
9. Agrawal VP, Akhtar M. Evaluation of Antibiotic Prescription Practices among General Surgeons in Nagpur. Sch J App Med Sci. 2015;3:2437-2440.
10. Afzal Khan AK, Mirshad PV, Rashed MR, Banu G. A study on the usage pattern of antimicrobial agents for the prevention of surgical site infections (SSIs) in a tertiary care teaching hospital. J Clin Diagn Res. 2013;7:671-674
11. Steinberg JP, Braun BI, Hellinger WC, et al. Timing of antimicrobial prophylaxis and the risk of surgical site infections: results from the Trial to Reduce Antimicrobial Prophylaxis Errors. Ann Surg. 2009;250:10-16.
12. Shah JN, Maharjan SB, Piya R, et al. Need of improvement in timing of prophylactic antibiotic in elective surgery. JNMA J Nepal Med Assoc. 2010;49:204-208.
13. Berrios-Torres SI. Evidence-based update to the U.S. Centers for Disease Control and Prevention and Healthcare Infection Control Practices Advisory Committee guideline for the prevention of surgical site infection: developmental process. Surg Infect (Larchmt). 2016;17:256-261.
14. Carvalho RLR, Campos CC, Franco LMC, Rocha AM, Ercole FF. Incidence and risk factors for surgical site infection in general surgeries. Rev Lat Am Enfermagem. 2017;25:e2848
15. Alamrew K, Tadesse TA, Abiye AA, Shibeshi W. Surgical Antimicrobial Prophylaxis and Incidence of Surgical Site Infections at Ethiopian Tertiary-Care Teaching Hospital. Infect Dis (Auckl). 2019;12:1178633719892267. Published 2019 Nov 27. doi:10.1177/1178633719892267
16. Shah K, Singh S, Rathod J. Surgical site infections: incidence, bacteriological profiles and risk factors in a tertiary care teaching hospital, western India. Int J Med Sci Public Health. 2017;6:173-176.
17. Lubega A, Joel B, Justina Lucy N. Incidence and etiology of surgical site infections among emergency postoperative patients in Mbarara regional referral hospital, South Western Uganda. Surg Res Pract. 2017;2017:6365172.
18. Halawi E, Assefa T, Hussen S. Pattern of antibiotics use, incidence and predictors of surgical site infections in a tertiary care teaching hospital. BMC Res Notes. 2018;11:538.
19. Nguyen D, MacLeod WB, Phung DC, Cong QT, Nguyen VH, Hamer DH. Incidence and predictors of surgicalsite infections in Vietnam. Infect Control Hosp Epidemiol. 2001; 22(8):485-92.
20. Setty NH, Nagaraja MS, Nagappa DH, Giriyaiah CS, Gowda NR, Laxmipathy Naik RD. A study on Surgical Site Infections (SSI) and associated factors in a government tertiary care teaching hospital in Mysore, Karnataka. Int J Med Public Health.2014; 4: 171-5.
21. Ntsama EC, Avomo J, Esiene A, Leme BL, Abologo AL, Masso MP, Essomba A. Prevalence of surgical site infections and evaluation of risk factors after surgery, case of three public hospitals in Cameroon. J Med Med Sci. 2013; 4(6):241-6.
22. Shrestha S, Wenju P, Shrestha R, Karmacharya RM. Incidence and Risk Factors of Surgical Site Infections in Kathmandu University Hospital, Kavre, Nepal. Kathmandu Univ Med J 2016;14:10
23. Sohn AH, Parvez FM, Vu T, Hai HH, Bich NN, Le Thi AT, Le Thi TH, Thanh NH, Viet TV, Archibald LK, Banerjee SN. Prevalence of surgical-site infections and patterns of antimicrobial use in a large tertiary-care hospital in Ho Chi Minh City, Vietnam. Infection Control & Hospital Epidemiology. 2002 Jul;23(7):382-7.
24. Patir R, Mahapatra AK, Banerji AK. Risk factors in postoperative neurosurgical infection: a prospective study. Acta Neurochir (Wien) 1992; 119:80-84
25. Tran TS, Jamulitrat S, Chongsuvivatvong V, Geater A. Postoperative hospital-acquired infection in Hungvuong Obstetric and Gynaecological Hospital, Vietnam. J Hosp Infect 1998;40:141-147
26. Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986–April 1997, issued May 1997. Am J Infect Control 1997;25:477-487.
27. Santos KR, Fonseca LS, Bravo Neto GP, Gontijo Filho PP. Surgical site infection: rates, etiology, and resistance patterns to antimicrobials among strains isolated at Rio de Janeiro University Hospital. Infection 1997;25:217-220
28. Gedebou J, Tassew A, Azene G. Frequency and resistance patterns of bacterial isolates from surgical patients in a teaching hospital in Addis Ababa. Tropical and Geographical Medicine 1983;35:133-138.