Risk Factors and Bacterial Profile of Abdominal Surgical Incisions- Changing Trends

Abstract

Introduction: Surgical Site Infections (SSIs) remain a significant postoperative complication after abdominal surgeries, even with the advancement of infection control practices. The emergence of drug resistance to routine antibiotics was a challenge to infected wound management. Aim: To analyse the host risk factors and bacterial flora associated with abdominal surgical site infections and to evaluate the changes in the prevalence and antibiotic susceptibility pattern over the years. Materials and Methods: A cross-sectional study was done among 150 abdominal surgery cases admitted to a Government Medical College Thrissur, (referral hospital) in Kerala, India for one year, from September 2010 to August 2011. Host risk factors were analysed by clinical details and preoperative investigations. Samples were collected from the wound site on the third day of surgery using sterile swabs for bacteriological analysis. Repeated samples were taken in case of suspected wound infection to identify the types of pathogen if any. Statistical analysis was done using Microsoft excel and open Epi software. The results were compared with the similar studies conducted in this institution during 2015-2016 and 2016-2017 to know the changes in prevalence and antimicrobial sensitivity. Result: Out of 150 cases higher infection rate was found in patients >60 years 5 (17.2%), emergency surgeries 16 (21.6%), large intestinal surgeries 4 (44.4%), with diabetes 5 (26.32%), patients on steroids and obese 3 (37.5%). Colonisers were present in 34.7% abdominal surgical wounds. Infection rate of 14.7% in abdominal surgeries was reduced to 11.2% and 10% between the years 2015-16 and 2016-17 respectively. Higher infection rate was noticed in patients with premorbid risk factors. When compared with the similar studies conducted in the same institute, Pseudomonas and Acinetobacter with E. coli and S. aureus were found to be most common wound pathogens and resistance to ciprofloxacin and ceftriaxone were increased. Amikacin, piperacillin tazobactam and imipenem were useful but decreasing in sensitivity were noticed. Conclusion: Bacterial colonisation with endogenous flora was the primary source of SSIs. Good infection control practices, early identification of the pathogen and treatment with an appropriate antibiotics can reduce the development of resistant organisms and cross infection. The use of antimicrobials for prophylaxis and treatment needed to be modified according to the antimicrobial sensitivity report and local susceptibility pattern.