Management Of Surgical Site Infections Research Articles

Challenges and strategies in the prevention and management of surgical site infections in general surgery: a comprehensive review

The present study addresses strategies for the prevention and management of surgical site infections (SSI) in general surgery. The importance of preoperative antibiotic prophylaxis, the preparation of the patient's skin, and the meticulous surgical technique in reducing the incidence of SSI are highlighted. During surgery, maintaining a sterile environment and minimizing tissue manipulation are crucial. After surgery, post-operative care, such as wound monitoring and patient education, is essential. SSIs negatively impact patient recovery and increase hospital costs. Implementing evidence-based practices is critical to improving patient safety and reducing costs associated with SSIs.

Negative pressure wound therapy in the management of postoperative spinal wound infections: a systematic review.

Postoperative wound infection after spinal surgery might be a challenge to manage. A wide range of procedures have been described for managing infected spinal wounds. An increasingly common procedure in the management of surgical site infections (SSI) is negative pressure wound therapy (NPWT), also known as vacuum-assisted closure. As there is a paucity of clear clinical advice the present investigation aims to update current evidence on the use of NPWT to manage postoperative SSI occurring after instrumented spine surgery. This systematic review was conducted according to the preferred reporting Items for systematic reviews and meta-analyses: the 2020 PRISMA statement. In January 2024, the following databases were accessed: PubMed, Web of Science, and Google Scholar. No time constraint was set for the search. All the clinical studies investigating the unique use of NPWT in treating postoperative spinal wound infections were accessed. A total of 381 patients were included in the present study. Of them 52.5% (200 of 381 patients) were women. The mean age was 52.2 ± 15.2years. The average length of the NPWT was 21.2days (range 7-90days). NPWT could be a valuable adjuvant therapy for the management of SSI after spine surgery. Additional high-quality investigations are required to assess the efficacy and safety of NPWT in SSI after spine surgery, especially if combined with contraindications or risk factors, such as the presence of intraoperative CSF leak. Level IV, Systematic review.

Efficacy and safety of negative wound pressure in the treatment of surgical complications after radical cystectomy: a retrospective cohort study

Background: Negative pressure wound treatment (NPWT) is a relatively new, but promising method for management of surgical site infection (SSI). The literature data on the use of NPWT for complications in oncology surgery, and after radical cystectomy (RC) in particular, is scarce.
 Aim: To evaluate the short-term results of NPWT dressings in the management of SSI after RC.
 Materials and methods: We retrospectively analyzed data from 446 patients who had RC with various uroderivation types in the Department of Oncourology of the N. N. Petrov National Medical Research Center of Oncology from January 2012 to December 2021. A total of 62 cases of SSI emerging up to day 30 after RC were identified with complete data. Thirty six (36) cases of SSI were managed according to standard procedures, and 26 patients with SSI were treated with NPWT (VivanoTec® S 042) at constant negative pressure mode. The physical condition of the patients before RC was assessed according to the American Society of Anesthesiology (ASA) classification, and the severity of the patient's condition at SSI diagnosis within APACHE II scale. The following parameters were also analyzed: body mass index, median number of days in the hospital, number of program wound sanitations (surgical debridement) or frequency of changing NPWT dressings, changes over time in C-reactive protein and leukocyte index of intoxication, and events of clinical interest (intestinal fistulas and lateralization of the median wound margins, hernias).
 Results: Most cases of post-RC SSIs were identified in men (57/62, 91.93%). The standard management and NPWT study groups were well balanced for age, body mass index, and ASA physical status. The median time from the first surgical debridement of the wound to its closure was significantly shorter in the standard surgical management group: 4 days (0; 8.75) versus 8.5 days (3.25; 12.0) in the NPWT group (p = 0.026). However, this did not negatively affect the length of hospitalization (28.08 ± 12.80 and 30.03 ± 16.27 days, respectively, p = 0.599). The 30-day mortality rates were not significantly different between the groups (p = 0.137). In our series with NPWT dressings, there were no cases of intestinal fistulas in the early and late postoperative periods.
 Conclusion: Negative pressure wound treatment is a safe and effective method of SSI management. It is not inferior to the generally accepted treatment standard with surgical wound debridement, staged sanitations or dressings. NPWT dressings allow for early primary muscular-fascial closure of the abdominal cavity and does not increase the duration of hospital stay, postoperative death rates and the risk of intestinal fistulas.

Predisposing Factors for Developing Surgical Site Infections

Surgical site infections (SSIs) continue to be a significant concern in surgical practice. This comprehensive review explores the epidemiology, risk factors, complications, and management of SSIs. A deep understanding of these predisposing factors is crucial for healthcare providers to implement effective preventive measures and minimize the impact of SSIs on patient outcomes

Yeasts as a Potential Causes of Surgical Site Infections at the Sourô Sanou University Hospital Center of Bobo-Dioulasso, Burkina Faso

Fungal surgical site infections (SSIs) trend to increase in the recent decades. This study aimed at estimating the prevalence of fungal SSIs, and the time of occurrence of fungal SSIs at the Sourô Sanou University Hospital (SSUHC) in Burkina Faso. This study was carried out in two departments of the SSUHC. Samples of postoperative purulent secretions were collected from June to December 2019. Purulent secretions swabs at the surgical site were aseptically collected using sterile cotton swabs. Standard mycology, CHROMagar, agglutination latex test and immunological test were used to identify the different Candida species. A total of 39 postoperative patients were included in the study. The median age was 27 years and the majority of patients were women (74.4%). The probability of isolating fungal agents from the surgical site was 2.6% three days after surgery. This probability was 14.4% and 49.5% at one week and 12 days after the surgical intervention, respectively. A total of 8 (20.51%) fungal species, all belonging to the genus Candida were identified in the study. These species were Candida albicans (3), Nakaseomyces glabrata (2), Candida tropicalis (2) and Pichia kudriavzevii (1). This study showed that Candida spp. could be the cause of the occurrence of SSIs at the SSUHC in Burkina Faso. So, physician must integrate the fungal causes in the management of SSIs.

Reducing the risk of surgical site infections.

Surgical site infections (SSIs) are commonly reported healthcare-acquired infections that can have a detrimental effect on patient outcomes and quality of life. SSIs are associated with longer periods of hospitalisation and increased patient morbidity and mortality. A rigorous approach is required to identify and manage the risk of infection across the preoperative, intraoperative and post-operative phases of care. This article describes the causes of, risk factors for development and signs and symptoms of SSIs. The author emphasises the importance of a collaborative, holistic and multidisciplinary approach to the prevention and management of SSIs, which involves the nurse and other healthcare professionals working in partnership with the patient.

Self-Reported Diagnosis and Management of Surgical Site Infection Highlights Lack of Objective Measures and Treatment Guidance.

Background: There is little guidance regarding empiric therapy for superficial surgical site infections (SSIs). Management of incisions with signs of SSI lacks consensus and management is variable among individual surgeons. Methods: The Surgical Infection Society was surveyed regarding management of SSIs. Cases were provided with varying wound descriptions, initial wound class (WC), post-operative day, and presence of a prosthesis. Responses were in multiple-choice format; statistics: χ2; α = 0.05. Results: Seventy-eight members responded. For appearance scenarios, respondents believed that both mild erythema (55%) and clear drainage (64%) could be observed, whereas substantial (>3 cm) erythema or purulence should be treated with complete (22% and 50%) or partial (55% and 40%) opening of the incision. Degree of erythema did not influence administration of antibiotic agents, but purulence was more likely than clear drainage to be treated with antibiotics (38% vs. 6%; p < 0.001). There were no differences based on WC, except that clean cases were more likely than higher WC scenarios to be treated with gram-positive coverage alone (WC 1 [26%] vs. 2 [10%] vs. 3 [13%] vs. 4 [4%]; p < 0.001). Post-operative day (POD) three appeared to be an inflection point for more aggressive treatment of suspected incisional SSI, with fewer (POD 0 [86%] vs. POD day 3 [54%]; p < 0.001) reporting observation. Respondents were more likely to obtain imaging, start broad-spectrum antibiotic agents, and return to the operating room for purulence in the presence of a mesh. Conclusions: Presented with escalating possibility of SSI, respondents reported lower rates of observation, increased use of antibiotic agents, and increased surgical drainage. Many scenarios lack consensus regarding appropriate therapy. The complete elimination of SSIs is unlikely to be accomplished soon, and this study provides a framework for understanding how surgeons approach SSIs, and potential areas for further research or pragmatic guidance.

Negative pressure wound therapy for the management of surgical site infections with zoonotic, drug‐resistant pathogens on the upper body of the horse

SummaryThis case series reviews the use of negative pressure wound therapy (NPWT) for surgical site infections (SSI) on the upper body of six horses at an academic referral institution between 2016 and 2020. The SSIs consisted of three ventral midline celiotomy incisions post‐abdominal exploratory, one paralumbar flank incision for removal of an ovarian abscess, an incision for resection of a septic jugular vein, and a large defect resulting from the resection of chronically abscessed skin and subcutaneous tissue on the shoulder and pectoral region. All SSIs contained zoonotic, polymicrobial, multi‐drug resistant pathogens (methicillin‐resistant Staphylococcus aureus or extended spectrum beta‐lactamase Klebsiella or Enterobacteriaceae) that were managed without systemic, regional, or topical antimicrobials. All horses were discharged from the hospital, and long‐term follow‐up revealed satisfactory functional and cosmetic outcomes according to owner questionnaires. Duration of NPWT ranged from 4 to 15 days in five horses, but one horse required NPWT for 70 days due to the large nature of the defect. The NPWT system was easy to use, well‐tolerated by patients, and produced acceptable functional and cosmetic outcomes for the clients. By containing wound exudate and reducing daily wound care, it improved hospital biosecurity and reduced exposure to hospital personnel.

Management of Surgical Site Infections in Spine Surgery: A Current Concept Review

Background: Surgical sites infections (SSIs) in spine surgeries represent one of the commonest hospital-acquired infections. SSIs refers to infection of surgical wound within 30 days of surgery or one year of implant usage. SSIs portend a huge disease burden with devastating consequences to the patient and the hospital facility with attendant physical and psychological trauma to the patient and it is associated with increase rate of morbidity and mortality. Objective: The aim of this review is to identify factors that predispose a spine patient to SSIs and to highlight the current preventive and management concepts. Methods: We carried out a comprehensive review of literatures, using key words such as surgical site infections, spine surgery, predisposing factors, prevention, diagnosis, treatment, outcomes on search engines of Google Scholar, Scopus and PUBMED. Eligible articles for the review included full length published articles in English which we have access to contents. Results: Twenty-five full length articles were found eligible for the review. In spite of improvement in spine care and surgery, SSIs continue be a source of great concern to the patients, surgeons and healthcare system of any nation. Gram positive organisms are more common than gram negative organisms. The risk factors for SSIs include patient- and surgeon - related factors. Albeit, there is no universally accepted protocol for the prevention and treatment of SSIs in spine surgery. The incidence of SSIs is on the increase worldwide with associated high risk of morbidity, overall decrease in the quality of life and sometimes mortality. The economic burdens of the management of SSI is huge and stressful for every nation. Treating SSIs after spine surgery is daunting as the choice between removing the implants for proper bacteria clearance and the risk of causing spinal instability is a hard nut to crack. Conclusions: Despite the improved surgical technique, protocol on asepsis and role of prophylactic antibiotics in clean spine surgeries, there are still substantial increase in the rate of SSIs. Therefore, prevention is more profitable than the hope of proper treatment.

Labor Related Factors That Contribute to Surgical Site Infections among Post Caesarean Section Mothers in Thika Level 5 Hospital

Caesarean Section is one of the most performed major surgical procedures carried out in obstetrics and constitutes about 15% of all deliveries worldwide, with Latin America being the highest at 29.2%. The study aimed to assess the labor related factors that contribute to surgical site infections among post caesarean section mothers in Thika Level 5 Hospital. The study design was a mixed unmatched case-control study which followed all mothers who had undergone caesarean section in maternity unit at Thika Level 5 Hospital and who had or did not have Surgical Site Infection from delivery up to two weeks post-delivery and nurse in-charges of maternity unit. The findings of the study informed the institution management on the determinants of surgical site infection following caesarean section, and took necessary precautions and surgical site care and management to prevent occurrence of surgical site infection in future. The findings revealed that prevalence of SSI was low among post Caesarean Section mothers at Thika Level 5 Hospital, with only 24.4% of the Caesarean Section mothers at Thika Level 5 Hospital found to have experienced SSI. The study in addition found that labor related factors had significant association with surgical site infections. Cases who had labor more than 8 hours were 3.12[95%CI=1.881 – 9.279, p&lt;0.013] times more likely to have surgical site infections compared to controls. Cases who had ruptured membrane more than 24 hours were 3.85[95%CI=2.810 – 12.027, p=0.000] times more likely to have surgical site infections compared to controls. Finally, Cases whose indication of CS was previous CS scar were 7.41[95%CI=3.88 – 9.56, p=0.022] times more likely to have surgical site infections compared to controls. The study also concluded that most SSIs are preventable as Thika Level five hospital is employing different measures to reduce cases of SSI at the facility. It is thus recommended that the management of Thika Level 5 Hospital should pay a close attention to labor related factors that are likely to cause surgical site infections among post caesarean section mothers being admitted in the facility. The study also recommended that a continuous education program for healthcare workers and young new mothers is necessary and can be feasible and potentially successful, given the interest expressed by healthcare workers in the management of surgical site infections. Keywords: Labor Related Factors, Surgical Site Infections, Post Caesarean Section

Update on the Management of Surgical Site Infections.

Surgical site infections are an increasingly important issue in nosocomial infections. The progressive increase in antibiotic resistance, the ever-increasing number of interventions and the ever-increasing complexity of patients due to their comorbidities amplify this problem. In this perspective, it is necessary to consider all the risk factors and all the current preventive and prophylactic measures which are available. At the same time, given multiresistant microorganisms, it is essential to consider all the possible current therapeutic interventions. Therefore, our review aims to evaluate all the current aspects regarding the management of surgical site infections.

Negative Pressure Wound Therapy in Spinal Surgery

Negative pressure wound therapy (NPWT) has demonstrated promise in the management of surgical site infections as well as assisting in surgical wound healing. In this manuscript, we describe the mechanisms and applications of NPWT for surgical wounds and existing evidence for NPWT in cardiac, plastic, and general surgery, followed by a discussion of the emerging evidence base for NPWT in spinal surgery. We also discuss the different applications of NPWT for open wounds and closed incisions, and the promise of newer closed-incision NPWT (ciNPWT) devices. There is nominal but promising prospective evidence on NPWT's efficacy in select at-risk populations for post-operative wound complications after spinal surgery. As there is currently a paucity of robust clinical evidence on its efficacy, rigorous randomized prospective clinical trials are needed.

Carbapenem-Resistant Organisms Isolated in Surgical Site Infections in Benin: A Public Health Problem.

An alarming worldwide increase in antimicrobial resistance is complicating the management of surgical site infections (SSIs), especially in low-middle income countries. The main objective of this study was to describe the pattern of carbapenem-resistant bacteria in hospitalized patients and to highlight the challenge of their detection in Benin. We collected pus samples from patients suspected to have SSIs in hospitals. After bacterial identification by MALDI-TOF mass spectrometry, antimicrobial susceptibility was performed according to the Kirby–Bauer method. Carbapenem-resistant strains were characterized using, successively, the Modified Hodge Test (MHT), the RESIST-5 O.K.N.V.I: a multiplex lateral flow and finally the polymerase chain reaction. Six isolates were resistant to three tested carbapenems and almost all antibiotics we tested but remained susceptible to amikacin. Four (66.7%) of them harbored some ESBL genes (blaCTX-M-1 and blaTEM-1). The MHT was positive for Carbapenems but not for Pseudomonas aeruginosa and Acinetobacter baumannii. As surgical antimicrobial prophylaxis, five of the six patients received ceftriaxone. The following carbapenems genes were identified: bla OXA-48(33.3%, n = 2), blaNDM (33.3%, n = 2) and blaVIM (33.3%, n = 2). These findings indicate a need for local and national antimicrobial resistance surveillance and the strengthening of antimicrobial stewardship programs in the country.

Use of antibiotic-impregnated beads in the treatment of lumbosacral surgical site infection: A retrospective case series

BackgroundDifferent adjuvant local-antibiotic techniques are described in management of surgical-site infections (SSIs). Antibiotic-laden polymethyl methacrylate (PMMA) spacers have been used in peri-prosthetic infections. However, their role in treatment of spinal SSIs is not well-recognised. MethodsAfter approval from Institutional Review Board, we retrospectively evaluated the data of patients aged≥18 years, who were treated for SSIs of lumbo-sacral region (2010–2019). Among them, those who underwent treatment with the placement of cement beads (temporarily/permanently) were identified. This approach was utilised for post-surgical spondylodiscitis patients with significant, associated infection or abscess involving the paraspinal musculature. Only those with≥2 years’ follow-up, were included.Patient demographic details, site of infection, details regarding laboratory/radiological investigations, management-protocol followed, pathogen grown, antibiotics used (their dosage and duration of use), complications encountered and outcome were recorded. Results13 patients [4 males, age:57.3 ± 12.4 years] were included. Seven had co-morbidities. One had upper-lumbar involvement, one sacral and others had lower-lumbar (L4/distally) disease. While 7 had recent-onset infection (≤2 months since primary surgery), 6 had chronic infection. In 2, 8, 2, and 1 patients, primary surgery was microdiscectomy, TLIF, PLF, and adult-deformity surgery, respectively.Nine underwent two-staged intervention and 4 underwent single procedure. Eleven had PMMA beads, while 2 underwent calcium sulphate bead insertion. Culture grew E coli in 3, Pseudomonas in 2; and E fecalis, K pneumoniae, MSSA and MRSA in one patient each. In 4 patients, beads were not removed. All patients underwent 2 weeks of parenteral antibiotics, followed by 8–12 weeks of oral medications. There was complete remission in all patients, except one who required additional VAC therapy. ConclusionLocal antibiotic-laden bead application is an effective adjuvant strategy (along with debridement and systemic antibiotics) for the treatment of spinal SSI, where there is substantial infection involving the paraspinal musculature. It is cost-effective and often necessitates second procedure for bead removal.

Early versus delayed debridement for surgical site infection after oncological neurosurgery.

Background: There are no guidelines on the management of surgical site infection (SSI) in neurosurgery. This study sought to analyze whether early debridement improved survival compared to antibiotic therapy alone in patients with postcraniotomy infections after oncological neurosurgeries.Methods: We retrospectively reviewed patient records from 2011 to 2019 to identify patients that had been reoperated for the debridement of SSI after brain tumor resection. If SSI was suspected but not clinically evident, the diagnosis was confirmed by cerebrospinal fluid (CSF) analysis or contrast-based imaging examinations. Immediately after diagnosis, broad-spectrum antibiotics were started for all patients.Results: Out of 81 SSI cases, 57 underwent debridement. Two patients were reoperated 3 times, and three had two surgeries, resulting in a total of 64 procedures. The number of days between SSI diagnosis and surgical intervention did not influence mortality in both univariate and multivariable analyses (Hazard ratio [HR] 1.03, 95% CI 0.93–1.13). Early debridement (<24 h) did not influence rates of antibiotic prescription at discharge (P = 0.53) or hospital length of stay (LOS) (P = 0.16). Higher neutrophil-lymphocyte ratios (NLRs) were associated with the lower survival (HR 1.05, 95% Confidence interval [CI] 1.01–1.08). Multiple cutoffs were tested and values above 3.5 are more significantly associated with worse outcomes (HR 2.2; 95%CI 1.1–4.2).Conclusion: Early debridement does not seem to influence the survival, rates of antibiotic at discharge, or hospital LOS of patients presenting with SSI after neurosurgery for intracranial tumors. High NLRs are strong predictors of worse prognosis in this population.

Incidence and management of surgical site infection in the cervical spine following a transoral approach.

Transoral approach can accomplish ventral decompression directly. However, surgical site infection (SSI) cannot be ignored. This paper aims to review the prevalence of infection and conduct advice for the treatment of SSI in the cervical spine following the transoral approach. A retrospective analysis of patients with SSI after transoral atlantoaxial reduction plate (TARP) surgery was performed. SSI was classified into three kinds according to the modified American CDC criteria. 2.9% (17/581) patients who underwent TARP surgery, experienced SSI, of which five had superficial SSI (SI), eight had deep SSI (DI), and four had organ/space SSI (O/SI). The patients with SI underwent intravenous antibiotic treatment and were ultimately cured. Among the remaining 12 patients with DI and O/SI, 11 underwent reoperation for TARP system removal and subsequently one-stage posterior occipitocervical fixation, and one patient experienced infection twomonths post-operatively and died without receiving treatment. Among patients who underwent revision surgery, three experienced intracranial infection due to intra-operative dural tears, and continuous lumbar cerebrospinal fluid drainage and intrathecal injection of antibiotics were used as effective and appropriate treatments, with outcomes of one recovery and two deaths. All patients with SSI were begun on intravenous antibiotics with conversion to oral antibiotics. The incidence of SSI was 2.9% (17/581). Adequate peri-operative preparation, early diagnosis, and appropriate treatment of SSI require further research.

Innovative Approaches to the Management of Surgical Site infection with Secretome from Placental Wharton Jelly Stem Cell (SC-PWJSC)

Surgical site infection is one of the postoperative complications that occur within 30 days after surgery. Surgical site infection is one of the causes of increased postoperative morbidity and mortality, with the probability of successful wound healing being less than 50% with conventional methods. One of the innovative methods of managing surgical site infections is using Secretome From Placental Wharton Jelly Stem Cell (SC-PWJSC). This report discusses the case of a 57-year-old man who experienced surgical site infection after a lower leg amputation. The patient was given treatment using Secretome From Placental Wharton Jelly Stem Cell (SC-PWJSC) by injection once on the first day, and topically used twice a day. During 28 days of treatment, the wound healing was perfect without any side effects resulting from this intervention.

Outcome of Patients with Surgical Site Infection after Craniotomy.

Background: The management of surgical site infection (SSI) after craniotomy remains challenging with few existing recommendations. Patients and Methods: We reviewed the medical files of patients who underwent surgery between 2009 and 2018 to manage infection after craniotomy at our tertiary hospital. The Cox proportional hazards model and the Renyi test were used to investigate the association between relapse or all-cause mortality and selected variables. We compared infections with and without intra-cranial involvement using the Fisher test and the Wilcoxon rank sum test. Results: Seventy-seven episodes of infection were identified in 58 patients. The proportion of relapse was estimated to be 32.2% (± standard deviation [SD] 6.9) at five years. Intra-cranial infection was present in 15.6% of the cases (n = 12). Bone flap was removed in the majority of cases (93.5%) and the overall median duration of antibiotic therapy was six weeks (interquartile range [IQR] 6-12 weeks). Staphylococcus aureus was associated with a higher risk of relapse (p = 0.037). The administration of parenteral antibiotic agents (p = 0.012) and bone flap removal (p = 0.0051) were correlated with less relapse. In contrast, immunosuppressive drug use and radiotherapy were correlated with a higher risk of relapse (p = 0.014 and p = 0.031, respectively) and a higher all-cause mortality (p = 0.0093 and p < 0.0001, respectively). We found no difference between infections with and without intra-cranial involvement. Conclusions: Bone flap removal and parenteral antibiotic agents remain important in the management of SSI after craniotomy and were associated with less relapse in our study. More studies are needed to better determine the optimal treatment of this infection.

A clinical study of risk factors and the management of surgical site infections in general surgical cases at tertiary care center: A two-year observational study

Background: Surgical site infections penetrate to depths in tissues and cause simple superficial infections to sepsis. The aim of this study is to identify the incidence rate of surgical site infections and their risk factors at the surgical section of a tertiary care center.&#x0D; Material and Methods: This retrospective observational study included 245 patients. The CDC class-wise breakup of would infection and the risk factors were recorded.&#x0D; Results: The Incidence of surgical site infections was 11.4%. &lt;20year aged patients showed 0% incidence, and &gt; 60-year aged patients showed 22.7% incidence. Malignancy observed as 31.3% incidence than without malignancy (10%) risk factor (p = 0.024). Among the origin, Lumbar sympathectomies and Breast surgery for malignancy showed the highest incidence (43.8%), followed by Genitourinary tract surgeries with 22.9%. Wound infection was more in an emergency (15.4%) than elective procedures (10.4%). The incidence rate increases from 7.9% (&lt;1 hr) to 14.7% (1-2 hrs) regarding the duration of Surgery. The association of wound class with wound infection showed 13% (clean), 3.3% (clean-contaminated), 17.9% (contaminated) the incidence of the study. The antibiotics usage shows a strong association with wound infection (p=0.015). The most common bacteria isolated were Staphylococcus and Streptococcus, Escherichia and Klebsiella species (60% both), followed by Pseudomonas, Citrobacter, and others.&#x0D; Conclusion: The factors which showed a strong association with wound infection were increasing age, surgical procedure, site of operation, presence of malignancy, urinary tract infection, lower respiratory tract infections, and exposure to antibiotics. Combination of clinical and microbiological means was the common mode of detection rather than individually.

Management of surgical site infection in oral cancer surgery

Management of surgical site infection in oral cancer surgery