STUDY OF CLINICO BACTERIOLOGY OF POST OPERATIVE WOUND INFECTION

Abstract

Introduction: Globally, surgical site infections (SSI) are known to be most common nosocominal infections in hospitalized patients after urinary tract infection. There are many studies which showed surgical site infection rates are reported globally as it range from 2.5% to 41.9% resulting in high morbidity and mortality. Surgical infections are those which caused infection as a result of a surgical procedure or those that require surgical intervention as part of their treatment which are characterized by breaking of anatomic defense mechanisms and are associated with greater morbidity, significant mortality, and increased cost of care. Though increasing the advance technology in surgical sciences post operative wound infection remains one of the common complications which surgeons encounter. If this problem is not evaluated and treated in timely then it can have significant sequel. The cutaneous or mucosal barrier, entrance of microbes into the host tissue is the initial requirement for infection. In SSI patient stays in hospital may be double the length of time and also increase the costs of health care. The main extra cost may be related to re-operation, extra nursing care and interventions, and drug treatment costs.
 AIM: The main aim of this study was to estimate the frequency of SSI with reference to factors contributing to it and the antimicrobial susceptibility pattern in surgery wards.
 Material and Methods: For this study patients were included as they were admitted in the surgical wards and the surgical emergencies that underwent surgical procedure in this hospital. The surgical procedures were classified as planned (elective) surgeries, emergency surgeries and clean, clean-contaminated surgeries, contaminated and dirty patients were divided accordingly. The discharged of infected wound were collected in sterilized container or the pus swab were collected aseptically procedure and send to microbiology laboratory for further process. By consulting with microbiologist the result were recorded.
 Result: On the base of surgeries were done total 452 cases were preformed. Out of 452 cases there were 132 cases in emergency out of which 29 get infected and in 320 elective cases 20 got infected. The overall rate of surgical site infection (SSI) was 10.8%. The occurrence of SSI in emergency cases (22%) was found to be higher compared to elective cases (6.3%). Out of total cases send for the culture and sensitivity, organism cultured gram negative organism predominate and and commonest was Escherchia coli, followed by Klebsiella, Pseudomonas and Staphylococcus aureus. E.coli and Klebsiella from emergency cases showed resistance to ciprofloxacin (83%) and ceftraixone (83%) and elective cases showed resistance of 70 % to ciprofloxacin and 40% to ceftriaxone. Therefore it was found that occurrence of SSI is significantly more in emergency cases.
 Conclusion: In this study rate of surgical site infection (SSI) was 10.8% whereas in clean 5.6%, in Clean and Contaminated 7.3% , in contaminated 21.2% and in dirty 25.9%. In gram negative bacteria E.coli were most commonly isolated bacteria followed by Pseudomonas and Klebsiella and in gram positive bacteria Staphylococcus aereus were most common isolated bacteria. Therefore antibiotics sensitive to the gram negative and pram positive bacteria should be initiative for establishing improved hospital antimicrobial policy and antimicrobial prescribing guidelines.
 Keywords: Surgical Site Infection, Post-operative wound infections, Antimicrobial resistance