Surgical site infection in surgery ward at a tertiary care hospital: the infection rate and the bacteriological profile

Abstract

Background: Surgical Site Infections (SSI) constitute a major fraction of nosocomial infections and occur in superficial incisional, deep incisional, and organ\space locations. The bacteriological profile of SSI and their antibiotic-susceptibility-pattern; aims towards planning proper treatment of SSI. Objectives: To determine the SSI rate MIS (Minimally Invasive Surgery) vs OS (Open surgery) during the study period, the bacteriological profile of SSI & their antibiotic-susceptibility-pattern, and to build up guidelines for empirical treatment of SSI till antibiotic sensitivity results are procured. Design: Prospective, randomized, hospital based study. Materials and Methods: The study included 784 patients; undergoing either OS or MIS\laparoscopic surgery from May 2009 to April 2011; at surgery department of hospital, among which; 72 cases of SSI was observed. Aspirated secretion\pus\wound swab was obtained from operation site of all the cases and cultured aerobically and an-aerobically using standard microbiological techniques. For control, skin swabs were collected from proposed incision site; prior to surgical draping; and bacterial culture attempted in all the subjects. The isolates were processed as per standard test guidelines. Antibiotic susceptibility tests were done by Kirby-Bauer technique. Results: Rate of SSI was 2.06% vs 16.16% in MIS vs OS. Most predominant pathogen was Staphylococcus aureus, predominantly Oxacillin resistant Staphylococcus aureus (ORSA-56.5%). Superficial SSIs were predominated by S.aureus. Deep SSI was predominated Klebsiella sp. ORSA were highly sensitive to vancomycin and linezolide. All ESBL producing isolates were highly sensitive to imipenem. Conclusions: Multidrugresistant (MDR) bacteria have profound role in SSIs. Empirical antibiotic therapy essentially to be started at clinicians end; before receiving the antibiotic susceptibility test results; may include therapy with amikacin and piperacillintazobactum or amikacin and cefoperazonesulbactum & must be switched over to vancomycin or linezolide when ORSA is the causative agent or, to other suitable antibiotics in case of ESBL producing etiology; strictly; as directed by microbial culture and antibiotic susceptibility test report. Keywords––Antibiotic stewardship, Empirical antibiotic therapy, Minimally invasive surgery, Multidrugresistant bacteria, Open surgery, Oxacillin resistant Staphylococcus aureus, Surgical site infection