Cause Of Surgical Site Infections Research Articles

Postoperative surgical site infection in cholesteatoma surgery with and without mastoid obliteration, what can we learn?

IntroductionThis study aims to describe the occurrence of postoperative complications related to cholesteatoma surgery and to determine factors influencing the most common complication, i.e. postoperative surgical site infection (SSI) in cases with and without mastoid obliteration. Materials and methodsRetrospective analyses were performed on surgically treated cholesteatomas in our hospital between 2013 and 2019. Patient characteristics, peri- and postoperative management and complications were reviewed. The cases were divided into two groups based on whether mastoid obliteration was performed or not. ResultsA total of 336 cholesteatoma operations were performed, of which 248 cases received mastoid obliteration. In total 21 complications were observed, of which SSI was the most common (15/21). No difference in occurrence of any postoperative complication was seen between the obliteration and no-obliteration group (p = 0.798), especially not in the number of SSI (p = 0.520). Perioperative and/or postoperative prophylactic antibiotics were not associated to the development of an SSI in both groups. In the no-obliteration group a younger age (p = 0.015), as well as primary surgery (p = 0.022) increased the risk for SSI. In the obliteration group the use of bioactive glass (BAG) S53P4 was identified as independent predictor of SSI (p = 0.008, OR 5.940). DiscussionSSI is the most common postoperative complication in cholesteatoma surgery. The causes of SSI are multifactorial, therefore further prospective research is needed to answer which factors can prevent the development of an SSI in cholesteatoma surgery.

Bacterial Contaminants on Exposed Surfaces and Their Antibiotic Sensitivity Patterns at the Benjamin Mkapa Hospital, Dodoma-Tanzania

Background: Hospital acquired infection pose a great challenge in provision of healthcare services to many settings particulary in developing countries where there is limited availability of resources. The roles played by exposed surfaces in spreading of potential bacterial pathogens within the hospital environment have certainly contributed to the increased burden of bacterial infectious diseases such as morbidness, death as well as cost imolecation in healthcare. Our study aimed to determine common bacteria isolated on exposed surfaces and the antimicrobial sensitivity patterns.
 Methods: A sum of 516 specimens gathered and enrolled for study at Benjamin Mkapa Hopsital (BMH). The swab specimens were continuously gathered (collected) from different exposed objects in hospital environmental surfaces. All microbiological procedures or tests were performed using appropriate standard operating procedure. The obtained data were analysed using SPSS version 16.0.
 Results: Among 516 samples, 317 (61.4%) were positive with variety of bacterial isolates from different sites. Out of 317 positive cultures, 120 (37.9%) Staphylococcus aureus, 97 (30.6%) E. coli, 28 (8.8%) Enterobacter aerogenes, 25 (7.9%) Pseudomonas aeruginosa, 23 (7.3%) other Citrobacter species, 20 (6.3%) Citrobacter freundii, 3 (0.9%) Morganella morganii and 1 (0.3%) Serratia mercesens were isolated from different source of exposed surfaces at BMH. Serratia mercesens were highly (100%) resistant to most of the antimicrobial agents including erythromycin, cefotaxime, ciprofloxacin, gentamicin, amikacin, penicillin,ceftriaxone, ceftazidime, levofloxacin, ampicillin, azithromycin and cotrimoxazoleTrimethoprim/sulfamethoxazole.
 Conclusion: High levels of potentially pathogenic bacteria were isolated in swab specimens from a wide range of exposed surfaces at BMH. Variable pattern of antiobiotic resistance were observed among bacterial isolates with alarming levels demonstrated by isolates of Serratia mercesens which is amongst the common causes of surgical site infections. This findings call for improved actions for infection prevention and control measures at BMH.

Whole Genome Sequencing and Antimicrobial Resistance of Staphylococcus aureus from Surgical Site Infections in Ghana.

Staphylococcus aureus (S. aureus) is a common cause of surgical site infections (SSIs) globally. Data on the occurrence of methicillin-susceptible S. aureus (MSSA) as well as methicillin-resistant S. aureus (MRSA) among patients with surgical site infections (SSIs) in sub-Saharan African are scarce. We characterized S. aureus from SSIs in Ghana using molecular methods and antimicrobial susceptibility testing (AST). Wound swabs or aspirate samples were collected from subjects with SSIs. S. aureus was identified by matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF-MS); AST was performed by Kirby-Bauer disk diffusion, and results were interpreted according to the Clinical and Laboratory Standards Institute (CLSI) guideline. Detection of spa, mecA, and pvl genes was performed by polymerase chain reaction (PCR). Whole-genome sequencing (WGS) was done using the Illumina MiSeq platform. Samples were collected from 112 subjects, with 13 S. aureus isolates recovered. Of these, 92% were sensitive to co-trimoxazole, 77% to clindamycin, and 54% to erythromycin. Multi-drug resistance was detected in 5 (38%) isolates. The four mecA gene-positive MRSA isolates detected belonged to ST152 (n = 3) and ST5 (n = 1). In total, 62% of the isolates were positive for the Panton-Valentine leukocidin (pvl) toxin gene. This study reports, for the first time, a pvl-positive ST152-t355 MRSA clone from SSIs in Ghana. The occurrence of multi-drug-resistant S. aureus epidemic clones suggests that continuous surveillance is required to monitor the spread and resistance trends of S. aureus in hospital settings in the country.

The Effect of Operating Room Size on Orthopaedic Surgical Site Infection Rates.

With many preventable causes of surgical site infections (SSIs) identified, the effect of operating room (OR) size on SSI rates has not been assessed. This study investigated the effect of OR size on incidence of SSIs for orthopaedic procedures. SSIs remain a common complication within the perioperative realm. Responsible for increasing length of hospitalization and costs, SSIs result in a decreased quality of life for patients. A retrospective review of 11,163 patients who underwent orthopaedic surgery-including total knee and hip arthroplasties, laminectomies, and spinal fusions-between January 2018 and January 2020 were reviewed. Total net square footage (NSF) of all ORs was recorded, and incidence of SSIs was calculated. Cases were categorized based on the size of the OR (small: 250 to 399 NSF; medium: 400 to 549 NSF; and large: 550 to 699 NSF). Chi-square analysis compared infection rates between the different OR sizes, and a binary logistic regression model identified other predictors of infection. Overall, 137 patients (1.2%) developed an SSI. Of these infections, 16 (11.7%) occurred in small ORs, 83 (60.6%) in medium ORs, and 38 (27.7%) in large ORs. The incidence of SSIs was 0.7% in small ORs, 1.3% in medium ORs, and 1.8% in large ORs. Factors found to significantly impact SSI's included medium-sized ORs, younger patients, procedure type (fusions and emergencies/traumas), longer procedures, and higher American Society of Anesthesiologists scores (>3). Our study shows that OR size in addition to various other perioperative parameters plays a role in the rate of SSIs for orthopaedic procedures. Retrospective Cohort Study; Level III Evidence.

Comparative Study of Bacterial Growth Inhibitory Effect of Three Types of Mouthwashes Marketed in Japan Containing Povidone Iodine, Benzethonium Chloride, and Chlorhexidine Gluconate by Bacterial Culture

Purpose: Pathogenic microorganisms in saliva are thought to be a major cause of surgical site infection in patients who have undergone surgery for head and neck or upper digestive tract cancers, and a common cause of postoperative pneumonia and aspiration pneumonia in elderly people. Gargling with a mouthwash containing an antiseptic agent is recommended to control salivary pathogen populations, but it is not clear which antiseptic agents are most effective. The purpose of this study is to examine the potencies of three antiseptic mouthwashes marketed in Japan against salivary bacteria.

Study of incidence and risk factors of surgical site infections in lower segment caesarean section cases of tertiary care hospital of north India

ObjectivesTo determine the incidence density, risk factors and common pathogens associated with surgical site infections (SSI) following lower segment caesarean section (LSCS) surgeries. MethodsIn this Non-interventional prospective observational study, a total of 611 post caesarean emergency and elective cases were enrolled among the 1018 LSCS cases conducted for the period of May–August 2016. The demographic, risk factors and clinical data for appearance of signs and symptoms of SSI were recorded in a preformatted proforma. SSI's were classified as superficial, deep and organ space as per Centre for Disease Control (CDC), USA definitions. Pus specimens were processed and antimicrobial susceptibility results of the organisms were determined as standard microbiological techniques. ResultsThe SSI rate was found to be 10.3 per 100 surgeries in our study with superficial SSI (66.7%) being most common. Inappropriate pre-surgical antibiotic prophylaxis, anaemia, previous LSCS as indication of LSCS, intra-operative blood transfusion and comorbid illness like heart disease, hypothyroidism, chronic liver and kidney disease were found to be significantly associated with SSI. Predominance of gram negative isolates (55.3%) was seen in comparison to gram positive isolates (44.7%) as cause of surgical site infections. ConclusionsSSIs rates observed are much higher than those observed in NHSN participating hospitals. Many of the risk factors identified are low hanging fruits and can be targeted to effectively reduce SSI rates.

Incidence and root causes of surgical site infections after gastrointestinal surgery at a public teaching hospital in Sudan

BackgroundSurgical site infections (SSIs) are common healthcare-associated infections and associated with prolonged hospital stays, additional financial burden, and significantly hamper the potential benefits of surgical interventions. Causes of SSIs are multi-factorials and patients undergoing gastrointestinal tract procedures carry a high risk of bacterial contamination. This study aimed to determine the prevalence, associated factors, and causing microorganisms of SSIs among patients undergoing gastrointestinal tract surgeries.MethodsA hospital based, cross-sectional study conducted at Soba University Hospital in Khartoum, Sudan. We included all patients from all age groups attending the gastrointestinal tract surgical unit between 1st September and 31st December 2017. We collected data about the socio-demographic characteristics, risk factors of SSI, and isolated microorganisms from patients with SSIs. A Chi-square test was conducted to determine the relationship between the independent categorical variables and the occurrence of SSI. The significance level for all analyses was set at p < .05.ResultsA total of 80 participants were included in the study. The mean age was 51 +/- 16 years and most of the patients (67.5%) did not have any chronic illness prior to the surgical operation. Most of them (46.3%) of them underwent large bowel surgery. Twenty-two patients (27.5%) developed SSI post operatively and superficial SSI was the most common type of SSIs (81.8%). Occurrence of SSI was found to be associated with long operation time (p > .001), malignant nature of the disease (p > .001), intra-operative blood loss (p > .001), and intra-operative hypotension (p = .013). The most prevalent microorganism isolated from SSI patients was E coli (47.8%), followed by Enterococcus fecalis (13.0%) and combined Pseudomonas aeruginosa + E coli infection (13.0%).ConclusionsThe results showed a high prevalence of SSIs among patients attending the gastrointestinal tract surgical unit and the most prevalent microorganism isolated from them was E coli. Measures should be taken to reduce the magnitude of SSI by mitigating the identified associated factors.

2-Methacryloyloxyethyl Phosphorylcholine Polymer Coating Inhibits Bacterial Adhesion and Biofilm Formation on a Suture: An In Vitro and In Vivo Study.

Initial bacterial adhesion to medical devices and subsequent biofilm formation are known as the leading causes of surgical site infection (SSI). Therefore, inhibition of bacterial adhesion and biofilm formation on the surface of medical devices can reduce the risk of SSIs. In this study, a highly hydrophilic, antibiofouling surface was prepared by coating the bioabsorbable suture surface with poly(2-methacryloyloxyethyl phosphorylcholine (MPC)-co-n-butyl methacrylate) (PMB). The PMB-coated and noncoated sutures exhibited similar mechanical strength and surface morphology. The effectiveness of the PMB coating on the suture to suppress adhesion and biofilm formation of methicillin-resistant Staphylococcus aureus and methicillin-susceptible Staphylococcus aureus was investigated both in vitro and in vivo. The bacterial adhesion test revealed that PMB coating significantly reduced the number of adherent bacteria, with no difference in the number of planktonic bacteria. Moreover, fluorescence microscopy and scanning electron microscopy observations of adherent bacteria on the suture surface after contact with bacterial suspension confirmed PMB coating-mediated inhibition of biofilm formation. Additionally, we found that the PMB-coated sutures exhibited significant antibiofouling effects in vivo. In conclusion, PMB-coated sutures demonstrated bacteriostatic effects associated with a highly hydrophilic, antibiofouling surface and inhibited bacterial adhesion and biofilm formation. Therefore, PMB-coated sutures could be a new alternative to reduce the risk of SSIs.

Cesarean Surgical Site Bacterial Infection

Background: The high incidence rate of surgical site infections (SSIs) highlights the need for prioritizing patient demographics, procedures, and surgical factors to be controlled by programs to reduce the infection rate. Objectives: This study detects the prevalence, causative organisms, and explores the relation between the air contamination in the operative theater and the SSI. Methodology: Cross sectional one-year study from January 2019. One hundred and seventy-two women were involved underwent CD. Intraoperative air sampling was performed during 83 surgery and bacterial air contamination were identified. Follow up for the patients 30 days after surgery was done to detect hospital acquired and community acquired SSI. Two samples were taken from the patient wound with SSI. Microbiological identification and antibiotics susceptibility testing for the isolates were done. The clonal relationships between the same species of isolates from air and wound were studied by evaluating the genomic DNA with PFGE analysis. Results: 14.5 % was the total SSI rate; 6.4%, developed hospital acquired SSI and 8.1% developed community acquired SSI. Most SSI cases yielded growth of Staphylococcus spp. (39, 3%) followed by Pseudomonas spp. (32.1%) and finally Escherichia coli (28.6%). Six wound isolates belonged to two air isolates pulsotype and the rest of isolates showed unsimilar pulsotype of interest. Conclusions: air contamination one of the causes of SSI and measures are recommended to reduce its incidence, including the implementation of infection prevention practices and the administration of antibiotic prophylaxis with strict surgical techniques. Most common cause of community acquired SSI was bad hygiene.

Implant contamination as a cause of surgical site infection in spinal surgery: are single-use implants a reasonable solution? \u2013 a systematic review

BackgroundIn spine surgery, surgical site infection (SSI) is one of the main perioperative complications and is associated with a higher patient morbidity and longer patient hospitalization. Most factors associated with SSI are connected with asepsis during the surgical procedure and thus with contamination of implants and instruments used which can be caused by pre- and intraoperative factors. In this systematic review we evaluate the current literature on these causes and discuss possible solutions to avoid implant and instrument contamination.MethodsA systematic literature search of PubMed addressing implant, instrument and tray contamination in orthopaedic and spinal surgery from 2001 to 2019 was conducted following the PRISMA guidelines. All studies regarding implant and instrument contamination in orthopaedic surgery published in English language were included.ResultsThirty-five studies were eligible for inclusion and were divided into pre- and intraoperative causes for implant and instrument contamination. Multiple studies showed that reprocessing of medical devices for surgery may be insufficient and lead to surgical site contamination. Regarding intraoperative causes, contamination of gloves and gowns as well as contamination via air are the most striking factors contributing to microbial contamination.ConclusionsOur systematic literature review shows that multiple factors can lead to instrument or implant contamination. Intraoperative causes of contamination can be avoided by implementing behavior such as changing gloves right before handling an implant and reducing the instruments’ intraoperative exposure to air. In avoidance of preoperative contamination, there still is a lack of convincing evidence for the use of single-use implants in orthopaedic surgery.

High Prevalence of Gram-Negative Rod and Multi-Organism Surgical Site Infections after Pediatric Complex Tethered Spinal Cord Surgery: Preliminary Report from a Single-Center Study

Background: Surgical site infections (SSIs) are one of the most common complications following pediatric complex tethered spinal cord release. This patient population is similar in some ways to the neuromuscular scoliosis population, in which higher-than-expected rates of gram-negative SSIs have been identified. Methods: We conducted a single-center retrospective chart review of all patients who underwent complex tethered spinal cord release over a 10-year period between 2007 and 2017. Results: A total of 69 patients were identified, with 10 documented SSIs (14%). 50% of the SSIs were polymicrobial or included at least 1 gram-negative organism. Among the organisms isolated, 3 were fully or ­partially resistant to cefazolin, the most common antibiotic prophylaxis in this population. Conclusion: Among children undergoing complex tethered spinal cord release, gram-negative and polymicrobial infections are a significant cause of SSIs. Although further multicenter data are needed, these findings suggest that standard antibiotic prophylaxis with cefazolin may not be sufficient.

Microbial contamination in a pediatric surgery operation theatre

Background: In surgical patients, 38% of nosocomial/ health care associated infections are surgical site infections (SSI). The exogenous causes of SSI include microbial contamination of operation theatre environment, equipment, and personnel. The objective of this study was to generate local data involving microbial contamination of operation theatre environment, equipment, and personnel.&#x0D; Methods: This cross sectional survey was conducted in Pediatric Surgery Operation Theatre, Mayo Hospital, Lahore from August 2018 to September 2018. Samples for bacterial culture were taken by theatre sister and list in charge using cotton swabs moistened in normal saline. After informed consent, 53 samples were taken from the dominant hand and anterior nares of theatre staff (surgeons, nurses, theatre assistants and anesthetists), and 33 samples from operation theatre equipment and environment (laryngoscope, anesthesia machine, operation table, wall and floor of the theatre, dirty area, and store.). Air samples were collected by night staff using settle plate method on blood agar. After collection, all samples were transported to laboratory within 15 minutes, where pathologist performed antimicrobial susceptibility testing for all bacterial isolates using the Kirby-Bauer disc diffusion method.&#x0D; Results: This study had 24 (45%) of the samples from anterior nares, and 29 (55%) samples from dominant hand, while 33 samples were taken from theatre environment and equipment. Positive bacterial growth from theatre staff was seen in 9 (17%) out of 53 collected samples. Staphylococcus aureus was present in 5 (55.6%) of these 9 samples, while Staphylococcus epidermidis was present in 3 (33.3%), and 1 (11.1%) sample revealed Escherichia coli. In samples from operation theatre environment and equipment, 11 samples (33.3%) out of 33 samples had bacterial growth. Most common growth obtained was bacillus species (90.9%) either alone or as mixed growth, while 1 (9.1%) was Staphylococcus aureus.&#x0D; Conclusion: Despite observing standard protocols of theatre sterilization, microbial contamination was noted in 33.3% of samples collected from theatre and 17% from personnel. The main microorganism isolated from theatre environment and equipment’ samples was Bacillus (90.9%), and Staphylococcus aureus (55.6%) from theatre personnel.

Mobile phones in the orthopedic operating room: Microbial colonization and antimicrobial resistance.

Surgical site infections are a major cause of morbidity and mortality following orthopedic surgery. Recent efforts to identify sources of contamination in the operating rooms have implicated mobile phones. To investigate microbial colonization on the mobile phones of health care professionals in the orthopedic operating room. We conducted a cross-sectional study involving culture and sensitivity analysis of swabs taken from the mobile phones of orthopedic and anesthesia attendings, residents, technicians and nurses working in the orthopedic operating rooms over a period of two months. Demographic and cell phone related factors were recorded using a questionnaire and the factors associated with contamination were analyzed. Ninety-three of 100 mobile phones were contaminated. Species isolated were Coagulase-negative Staphylococcus (62%), Micrococcus (41%) and Bacillus (26%). The risk of contamination was increased with mobile covers and cracked screens and decreased by cell phone cleaning. Mobile phones belonging to health care workers are frequently contaminated with pathogenic bacteria with the potential of transferring drug resistance to nosocomial pathogens. Studies investigating the relationship to surgical site infections need to be conducted. The concept of "mobile hygiene" involving the change of mobile covers, replacement of cracked screens or even wiping the phone with an alcohol swab could yield the cost-effective balance that contaminated cell phones deserve until they are established as a direct cause of surgical site infections.

Surgical site infections after pancreaticoduodenectomy: Preoperative biliary system interventions and antimicrobial prophylaxis

BackgroundThe rate of surgical site infection (SSI) after pancreaticoduodenectomy (PD) is high and insertion of preoperative bile duct catheterization (PBDC) predispose a high risk of SSI with multidrug resistant (MDR) microorganisms. AimTo describe the effects of PBDC and the prophylaxis in development of SSI. MethodsWe conducted a retrospective study between January 01, 2010 and December 2018 including the patients with PD and total pancreatectomy. FindingsIn total 214 consecutive patients were included. The PBDC was inserted to 63 (29%) patients. The rate of intraoperative bile fluid culture positivity was higher among the patients with PBDC (84% vs. 17% respectively, p<0.001). The SSI was detected in 52 patients (24%). In multivariate analysis, the rate of SSI was found to be higher among the patients with PBDC (OR: 2.33, 95% Cl: 1.14–4.76, p=0.02). As the etiologic agents of SSI, Pseudomonas spp. and MDR pathogens were mainly detected in PBDC group. The resistance to ampicillin-sulbactam was significantly higher in the PBDC group (87.5% vs. 25%, p=0.012). The similar bacterial species both in bile fluid and the surgical site were detected in 11 (21%) patients with SSI. Among 8 patients (15%), antimicrobial susceptibility was the same. Only in five out of 52 (10%) patients, the SSI pathogens was susceptible to the agent that was used for surgical prophylaxis. ConclusionUnnecessary catheterizations should be avoided. By considering the increasing prevalence of resistant bacteria as the cause of SSI, the clinicians should closely follow-up their patients for choosing the proper antimicrobials.

Evaluation of the Effects of Iron Oxide Nanoparticles on Expression of TEM Type Beta-Lactamase Genes in Pseudomonas Aeruginosa

Pseudomonas aeruginosa is a common cause of surgical-site infections and healthcare-associated infections in the bloodstream, and urinary tract. Iron oxide nanoparticles (IONPs) have shown, to possess antibacterial features. The nanoparticles' status as emerging therapeutic elements has motivated investigators to assess the effects of iron nanoparticles on the expression of TEM type beta-lactamase genes in P. aeruginosa. In this descriptive-analytic study, 60 clinical isolates of P. aeruginosa were isolated from burn wounds and respiratory excretions of Pasargad Research Laboratory of Tehran, Iran. All isolates were characterized using differential biochemical tests and confirmed samples as P. aeruginosa. Their genomic DNA was extracted and PCR reaction was performed to screen TEM-gene carrying isolates. Then MIC of IONPs against these strains was determined and finally, Real-time PCR performed to the determination of the expression of the TEM gene. Results showed that 8 isolates (13/33%) had the TEM beta-lactamase gene. The MIC and MBC of IONPs against P. aeruginosa strains were observed at 256 µg/mL or 125 µg/mL, while the MBC was determined at 500 µg/mL. In addition, statistical analysis of Real-time PCR data showed that there is a statistically significant difference between gene expression levels of IONPs treated isolates and non-treated ones. The results showed that TEM gene expression levels in two isolates treated with IONPs were 78% and 75% lower than untreated bacteria (P<0.001; r= 0.958). Our findings confirmed that IONPs are potential antibacterial agents and can be considered as promising treatments for recalcitrant P. aeruginosa infections.

Prevalence of Bacterial Contamination of Casting Material in a Pediatric Population.

Surgical site infection is a relatively common and devastating complication following pediatric orthopedic surgery. Many infections have been determined to be the result of settled airborne particles on surgical equipment and the sterile field. Fiberglass casts are commonly used orthopedic fixation devices before and after surgery; however, fiberglass casting material is expelled during the removal process and represents an uninvestigated area for the possibility of cast saw dust as a source of airborne bacterial contamination in an operating room setting. This study evaluates the prevalence and distribution of microbiota on 90 pediatric casts by collecting and culturing fiberglass cast material from 90 pediatric casts. Bacterial identification was performed using a Bruker Biotyper Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry device. 81 out of 90 casts (90%) showed evidence of microbial contamination. Isolated species were very diverse and ranged from normal skin flora to opportunistic pathogens. The 5 most commonly isolated organisms were Acinetobacter pittii, Enterobacter cloacae, Micrococcus luteus, Staphylococcus epidermidis, and Staphylococcus hominis. Further investigation is required to determine if casting material is truly a cause of surgical site infection.

Prevalence and root causes of surgical site infections at an academic trauma and burn center in Ethiopia: a cross-sectional study

BackgroundDespite modern surgical techniques and the use of antibiotic prophylaxis, surgical site infection remains a burden for the patient and health system. It is a major cause of morbidity, prolonged hospital stay, and increased health costs. Thus, the main aim of this study was to determine the prevalence and root causes of surgical site infection among patients undergoing major surgery at an academic trauma and burn center in Ethiopia.MethodsA hospital based cross-sectional study was conducted on 249 patients during 6-months’ time window. Data entered in SPSS and multivariate logistic regression was employed to determine the root causes and the outcome variable.ResultsThe prevalence of surgical site infection was found to be 24.6% of whom 10% develop deep site, 9.2% organ spaced and the remaining 5.2% develop superficial space surgical site infection. The prevalence was high in patients who had undergone orthopedics (54.3%) and abdominal (30%) surgeries. Educational status, pre-morbid illness, duration of pre-operative and post-operative hospital stay, ASA score, and type of the wound were significantly associated with SSI at p-value of ≤0.05. However, no association was found with BMI and location of the wound.ConclusionsThe prevalence of surgical site infection in the study population is still high. Preoperative hospital stay, pre-morbid illness, pre-operative and post-operative hospital stay, ASA score, and type of the wound were the independent predictors of surgical site infection. The duration of pre and post-operative periods should be kept to a minimum as much as possible. Patients with pre-morbid history of chronic diseases and contaminated wound require special attention to decrease the rate of occurrence of infections. In addition, longitudinal studies should be carried out to identify more risk factors.

Prevalence and root causes of surgical site infection among women undergoing caesarean section in Ethiopia: a systematic review and meta-analysis

BackgroundSurgical site infection is a common complication in women undergoing Caesarean section and the second most common cause of maternal mortality in obstetrics. In Ethiopia, prevalence and root causes of surgical site infection post-Caesarean section are highly variable. This systematic review and meta-analysis estimate the overall prevalence of surgical site infection and its root causes among women undergoing Caesarean section in Ethiopia.MethodSystematic review and meta-analysis were conducted to assess the prevalence and root causes of surgical site infection in Ethiopia. The articles were searched from the databases such as Medline, Google Scholar and Science Direct. A total of 13 studies from different regions of Ethiopia reporting the prevalence and root causes of surgical site infection among women undergoing Caesarean section were included. A random effect meta-analysis model was computed to estimate the overall prevalence. In addition, the association between risk factor variables and surgical site infection related to Caesarean section were examined.ResultsThirteen studies in Ethiopia showed that the overall prevalence of surgical site infection among women undergoing Caesarean section was 8.81% (95% CI: 6.34–11.28). Prolonged labor, prolonged rupture of membrane, presence of anemia, presence of chorioamnionitis, presence of meconium, vertical skin incision, greater than 2 cm thickness of subcutaneous tissue, and general anesthesia were significantly associated with surgical site infection post-Caesarean section.ConclusionPrevalence of surgical site infection among women undergoing Caesarean section was relatively higher in Ethiopians compared with the report of center of disease control guideline. Prolonged labor, prolonged rupture of membrane, presence of anemia, chorioamnionitis, presence of meconium, vertical skin incision, greater than 2 cm thickness of subcutaneous tissue and/or general anesthesia were significantly associated with surgical site infection post-Caesarean section.

Surgical site infection and risk factors following right lobe living donor liver transplantation in adults: A single-center prospective cohort study.

Surgical site infection (SSI) is an important cause of decreased graft survival, prolonged hospital stay, and higher costs following living donor liver transplantation. There are several risk factors for SSI. In this cohort study, we aimed to investigate the incidence of SSI at our center and the associated risk factors. Adult right lobe living donor liver transplantations were included in this prospective cohort. Patients who died postoperatively within 3days; patients with infected ascites or open abdomen, cadaveric, or pediatric transplants; and patients with biologic or cryopreserved vascular grafts were excluded. Patients' demographic characteristics and perioperative surgical findings were recorded. SSI follow-up was continued for 90days. CDC-2017 criteria were used to diagnose SSI. In the presence of superficial, deep, and organ/space SSI, only the organ in the poorest condition was included in SSI evaluation. The patients were administered similar to antibiotic prophylaxes and immunosuppressive protocols. A total of 101 patients were enrolled in this study, of which 30 (29.7%) were diagnosed with SSI. Organ/space, only deep, and only superficial SSI were noted in 90% (27/30), 6.7% (2/30), and 3.3% (1/30) of the patients, respectively. Twenty-five of 30 patients with SSI had a remote site infection. One or more bacteria observed in cultures were obtained from 28 patients. A donor-recipient age difference of >10years, cold ischemia lasting for ≥150minutes, surgical duration of ≥600minutes, intraoperative hemorrhage of ≥1000mL, intraoperative blood transfusion, biliary leak or stricture, prolonged mechanical ventilation, prolonged intensive care unit and hospital stay, remote site infection, and the need for reoperation were associated with increased SSI incidence. Preoperative and intraoperative levels of blood glucose, albumin, and hemoglobin were not associated with SSI. A donor-recipient age difference of >10years, remote site infection, and biliary leak were found to be independent risk factors for SSI. Hospital mortality with and without SSIs was 6.7% vs 4.4%, P=.61. Organ/space SSIs were the essential part of SSIs following right lobe living donor liver transplantations. Donor-recipient age gap, prolonged cold ischemia time, complicated surgery, and postoperative biliary complications were the main causes of SSIs. Although they did not increase the perioperative mortality, they promote increased rate of reoperations, remote infections, prolonged intensive care unit, and hospital stays.

The prevalence and root causes of surgical site infections in public versus private hospitals in Ethiopia: a retrospective observational cohort study

BackgroundHealthcare-associated illnesses, of which surgical site infection is the most common are significant causes of morbidity and mortality. Therefore, this study aimed to determine the prevalence and root causes of surgical site infections in public versus private hospitals in Ethiopia.MethodsAn institution based retrospective observational cohort study was conducted among patients who underwent surgical procedures at public and private health facilities from March 15 to April 15, 2018. Samples were selected by the simple random sampling technique, and data extracted from the patient’s medical chart, operation, and anesthesia notes. Data were entered using Epi info version 7 and analyzed using STATA 14. Binary logistic regression was fitted to identify factors associated with surgical site infections in private and public hospitals. Crude and adjusted odds ratios (OR) with a 95% confidence interval (CI) were computed to assess the strength of associations. Variables with a p-value less than 0.05 in the multivariable logistic regression model considered as significant predictors of surgical site infections.ResultThe overall prevalence of surgical site infections was 9.9% (95%CI: 7.8, 12.5). The prevalence of the infections was higher in procedures performed in public hospitals (13.4%) compared to private hospitals (6.5%). Rural residence (AOR = 0.13, 95%CI: 0.034 0.55), clean-contaminated and dirty wound (AOR = 12.81, 95%CI: 4.42 37.08) were significant predictors of the infections in private hospitals. Similarly, clean-contaminated and dirty wounds (AOR = 4.37, 95%CI: 1.88 10.14), length of hospital stay≥6 days (AOR = 2.86, 95%CI: 1.11 7.33), and surgical operation time of over 1 h (AOR = 15.24, 95%CI: 4.48 51.83) were such factors in public hospitals.ConclusionThe prevalence of surgical site infections was high, and significant differences were also observed between public and private hospitals. Clean-contaminated and dirty wounds, prolonged operation, and length of hospital stay were predictors of surgical site infections among patients in public hospitals, whereas clean-contaminated wound and rural dwellings were predicted the infections among patients operated in the private hospital.