Risk Factors and Surgical Site Infection in Patients with Surgical Antibiotic Prophylaxis in the Indian Population: A Prospective Cohort Study

Abstract

Objective: To assess the risk factors and Surgical Site Infections (SSI) in patients with surgical antibiotic prophylaxis (SAP) within the Indian population. Material and Methods: A prospective cohort study, consisting of 1,362 patients, with the age of 18 and above; admitted for various surgical procedures, and prescribed with SAP were included. In order to determine the significance of categorical data, the chi-square test, and Multiple binary logistic regression via the backward wald method was used to identify the risk factors. Various risk factors and their association to SSI were assessed, with a probability value of ≤0.05 being considered as a significant level. Result: In total, 171 SSI were observed; with an incidence of 12.6% [95% CI=11.1-16.6] among all study patients (1,362). Cefotaxime was the most prescribed SAP in this study. In total 59.6% had gram-positive organisms and 40.4% had gram-negative organisms. Type of surgery, female gender, smoking and alcohol, diabetes with hypertension, microbial growth, American Society of Anesthesiologists (ASA) score (class III), hospital guidelines, and pre-operative hospital stays (>7 days) were the significant risk factors (p-value<0.05) associated with SSI. There was no significant association with drain use, nor redosing (p-value>0.05). Conclusion: This study emphasizes the significant risk factors; such as age, female gender, types of surgery, ASA score, nonadherence to hospital guidelines, monomicrobial and polymicrobial growth and poor compliance to SAP being associated with SSI in surgical patients. These risk factors allow a better understanding related to SSI, which may have therapeutic implications.