Abstract
Orthopedic surgeries contribute to overall surgical site infection (SSI) events worldwide. In India, SSI rates vary considerably depending on geographical location (1.6–38%); however, there is a lack of a national SSI surveillance system.. This study aims to identify the SSI incidence, risk factors, antibiotic prescription and susceptibility patterns among operated orthopedic patients in a teaching hospital in India. Data for 1205 patients were collected from 2013 to 2016. SSIs were identified based on the Centre for Disease Control and Prevention’s guidelines. The American Society for Anesthesiologists classification system was used to predict patients’ operative risk. Univariable and multivariable backward stepwise logistic regressions were performed to identify risk factors for SSIs. Overall, 7.6% patients developed SSIs over three years. Out of 68 samples sent for culture and susceptibility testing, 22% were culture positive. The most common SSI-causing microorganism was Staphylococcus aureus (7%), whose strains were resistant to penicillin (100%), erythromycin (80%), cotrimoxazole (80%), amikacin (60%) and cefoxitin (60%). Amikacin was the most prescribed antibiotic (36%). Male sex (OR 2.64; 95%CI 1.32–5.30), previous hospitalization (OR 2.15; 95%CI 1.25–3.69), prescription of antibiotics during hospitalization before perioperative antibiotic prophylaxis (OR 4.19; 95%CI 2.51–7.00) and postoperative length of stay >15 days (OR 3.30; 95%CI 1.83–5.95) were identified as significant risk factors for orthopedic SSIs. Additionally, a preoperative shower significantly increased the risk of SSIs (OR 4.73; 95% CI 2.72–8.22), which is unconfirmed in the literature so far.
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