Operative Surgical Site Infection Research Articles

Prevalence and Determinants of Post - Operative Surgical Site Infections at Amana Regional Referral Hospital, Tanzania: A Prospective Observational Study

Prevalence and Determinants of Post - Operative Surgical Site Infections at Amana Regional Referral Hospital, Tanzania: A Prospective Observational Study

Post Operative Surgical Site Infection: A Narrative Review

Background: Surgical Site Infections (SSIs) are a critical concern in postoperative care, significantly affecting patient outcomes and healthcare resources globally. These infections arise from the proliferation of microorganisms at the site of surgical intervention and are classified into early-onset (within 30 days of surgery) and late-onset (occurring more than 30 days post-surgery). Objective: This review aims to comprehensively analyze the prevalence, risk factors, and broader impact of SSIs, with an emphasis on the disparity between high-income and low- and middle-income countries (LMICs). Methods: An extensive literature review was conducted using databases such as Google Scholar and PubMed. The focus was on studies that detailed the incidence, risk factors, and prevention strategies of SSIs. Results: The review highlights a notably higher incidence of SSIs in LMICs compared to high-income countries. SSIs are a predominant cause of healthcare-associated infections (HCAIs) and are more frequently observed in emergency surgeries than elective procedures. Prominent risk factors identified include patient's age, type of surgery, specific microbial agents, blood transfusions, and comorbid conditions. Diabetes mellitus, reduced postoperative hematocrit levels, significant weight loss within six months prior to surgery, and ascites are strongly associated with an increased risk of SSI. In contrast, tobacco use, steroid use, and chronic obstructive pulmonary disease (COPD) were not found to be significant predictors. The role of surgical departments in reducing SSI occurrence through stringent antimicrobial protocols and thorough preoperative evaluations is also highlighted. Conclusion: SSIs present a significant challenge in global health, particularly in LMICs. Effective management of SSIs necessitates a multifaceted approach, incorporating improved infection control practices, individualized patient risk assessments, and international initiatives to reduce disparities. This review calls for increased awareness and targeted strategies to minimize the prevalence and impact of SSIs.

LOWER EXTREMITY ARTERY ANEURYSMS AND THEIR MANAGEMENT-AN INSTITUTIONAL EXPERIENCE

Objective: To study the clinical presentation, etiology and outcomes of Lower extremity aneurysms management at a teritiary care centre. Methodology: This is a retrospective study covering a period of 5 years from june 2018 to july 2023 conducted at the Institute of Vascular Surgery, Madras Medical College, Chennai. Case sheets were retrieved and reviewed from CMCHS database. Inclusion criteria: Patients with true aneurysms and pseudoaneurysms involving lower limb who were managed by surgery or endovascular means were included in the study. Exclusion Criteria: Pseudoaneurysms related to dialysis and Iliac artery aneurysms Results There were 23 patients who presented with aneurysms of the extremities that fell in the inclusion criteria. Of these 14 patients were male and 09 were female. Children (<18 years) constituted 14.2 % of patients. Youngest- 7-month-old boy- Right PFA Pseudoaneurysm Oldest - 72yrs old male- Left PFA Pseudoneurysm • Major vessels involved were SFA-8/23(34.7%) and common femoral artery 5/23(21.7%.). Complications developed in 4 of the 23 cases (17.4%), which included recurrent pseudoaneurysm, surgical site infection, post- operative hematoma and surgical site infection ending up in AK amputation. Limb salvage rate was- 95.6% Amputation rate- 4% (1 patient). Conclusion: Extremity artery aneurysms are uncommon. Majority are pseudoaneurysms. Results of both open surgery and endovascular management are excellent.

237 Delay in Ankle Fracture Fixation Against BOAST Guidelines for Ankle Fractures

Abstract Aim Ankle fractures are common, and the majority are the result of low energy torsional trauma. The aim of treatment is to restore and maintain stability and alignment of the joint, ideally with normal anatomy of the ankle mortise. According to BOAST guidelines for ankle fractures, Early fixation within 24-48 hours is recommended in the majority of patients under 60 years when the ankle mortise is unstable. This study aimed at assessing our practice in managing ankle fractures against BOAST guidelines and infection rate assessment. Method Data was collected respectively from electronic patient records for three months period and entered excel. First cycle results were presented in a departmental audit meeting and recommendations to improve practice were acted upon. Second cycle data was collected three months later and for three months period. Final re-audited results were presented in a departmental audit meeting. Results First cycle results: only 11% of patients had their ankle fractures fixed within 48 hours and none of them had surgical site infection. 65.2 % of patients had their operations over a week with an Infection rate of 10.6%. Second cycle results: 19% of patients had their ankle fractures fixed within 48 hours and none had surgical site infection. 47.6 % of patients had their operations over a week with an Infection rate of 4.8%. Conclusions Second cycle results showed improvement in operative timing and surgical site infections rate against BOAST guidelines compared to initial first cycle results. Early fixation for ankle fractures is associated with lower infection rates.

996 Circumcisions in the Community; a New Initiative

Abstract Introduction The average waiting time for an initial outpatient appointment in urology at UHL is 23 weeks and waiting times for circumcisions are significantly longer. A new initiative in Leicester has enabled a proportion of fit and healthy NHS patients to have their circumcision under LA within the community. Our aim was to audit our practice to determine if this initiative could be trialled across other urological departments in the UK. Method A prospective database has been maintained and 76 patients who underwent a circumcision in the community between November 2021 and August 2022 were identified. 16 patients were excluded since they were not contactable via telephone. Online hospital records and GP records were used in addition to contacting patients via telephone to collect data. Results The mean satisfaction level with the service provided was 8.28. The total post-operative complication rate was 35% with a 25% post operative surgical site infection rate. There were 2 (3.3%) admissions to hospital secondary to penile abscesses and possible skin necrosis of which both required drainage in theatre. The average length of admission for these patients was 2.5 days. 3 (5%) patients were unhappy with cosmesis, and 2 patients have had/are awaiting a redo circumcision. Conclusions Through this new initiative 76 patients have been removed from the NHS waiting lists for circumcision thereby reducing waiting times with very high patient satisfaction. This indicates that this new initiative could be trialled in other departments and could also be used to reduce waiting lists for other minor procedures.

FTP1.2 Delay in ankle fracture fixation against BOAST guidelines for ankle fractures

Abstract Aim Ankle fractures are common, and the majority are the result of low energy torsional trauma. The aim of treatment is to restore and maintain stability and alignment of the joint, ideally with normal anatomy of the ankle mortise. According to BOAST guidelines for ankle fractures, Early fixation within 24-48 hours is recommended in the majority of patients under 60 years when the ankle mortise is unstable. This study aimed at assessing our practice in managing ankle fractures against BOAST guidelines and infection rate assessment. Methods Data was collected respectively from electronic patient records for three months period and entered excel. First cycle results were presented in a departmental audit meeting and recommendations to improve practice were acted upon. Second cycle data was collected three months later and for three months period. Final re-audited results were presented in a departmental audit meeting. Results First cycle results: only 11% of patients had their ankle fractures fixed within 48 hours and none of them had surgical site infection. 65.2 % of patients had their operations over a week with an Infection rate of 10.6%. Second cycle results: 19% of patients had their ankle fractures fixed within 48 hours and none had surgical site infection. 47.6 % of patients had their operations over a week with an Infection rate of 4.8%. Conclusions Second cycle results showed improvement in operative timing and surgical site infections rate against BOAST guidelines compared to initial first cycle results. Early fixation for ankle fractures is associated with lower infection rates.

Short-term outcomes of robotic versus open hepatectomy among overweight patients with hepatocellular carcinoma: a propensity score-matched study

BackgroundRobotic hepatectomy (RH) has gradually been accepted as it has overcome some of the limitations of open hepatectomy (OH). This study was to compare short-term outcomes in RH and OH for overweight (preoperative body mass index ≥ 25 kg/m²) patients with hepatocellular carcinoma (HCC).MethodsPerioperative and postoperative data from these patients who underwent RH or OH between January 2010 and December 2020 were retrospectively analyzed. Propensity score matching (PSM) analysis was performed to determine the impact of RH versus OH on the prognosis of overweight HCC patients.ResultsAll 304 overweight HCC patients were included, 172 who were underwent RH, and 132 who were underwent OH. After the 1:1 PSM, there were 104 patients in both RH and OH groups. After PSM, the RH group of patients had a shorter operative time, less estimated blood loss (EBL), a longer total clamping time, a shorter postoperative length of stay (LOS), less chance of surgical site infection and less rates of blood transfusion (all P < 0.05) compared to the OH patients. The differences between operative time, EBL and LOS were more significant in obese patients. RH was found to be an independent protective factor of EBL ≥ 400ml relative to OH in overweight patients for the first time.ConclusionsRH was safe and feasible in overweight HCC patients. Compared with OH, RH has advantages in terms of operative time, EBL, postoperative LOS, and surgical site infection. Carefully selected overweight patients should be considered for RH.

Thickness of subcutaneous fat in the right iliac fossa as a predictor of surgical site infection in open appendicectomy- a single centre prospective study

Background: Acute appendicitis is the acute inflammation of appendix accounting to 7-10% of acute abdomen cases. The complications vary from surgical site infection to enterocutaneous fistula and stump appendicitis. The surgical site infections after appendicectomy are postoperative nosocomial infections affecting the incision site, deeper tissues and organs at the operative site within 30 days of surgery. The study was aimed at predicting subcutaneous fat thickness causing surgical site infection in open appendicectomy wounds. Methods: This prospective study was conducted in Trichy SRM Medical College Hospital and Research Centre, Tamil Nadu from January to June 2021 in 82 patients. Patients who underwent open appendicectomy for uncomplicated acute appendicitis were included. Patients underwent preoperative Ultrasound abdomen to measure the subcutaneous fat thickness in right iliac fossa and was correlated with post operative surgical site infection for 1 month. The subcutaneous fat thickness was divided into three groups; I- 5.5 mm and below, II- 5.5 to 7.5 mm and III- more than 7.5 mm. Results: The results show that there was an increased association of surgical site infection in patients with increased subcutaneous fat thickness at incision site with mean of 6.25 and SD of 1.49. Conclusions: The study showed that subcutaneous fat thickness is a predictor for development of surgical site infection in open appendicectomy wounds. The subcutaneous fat thickness association in causing surgical site infection in open appendicectomy wounds is of linear association.

SJLA_2024_A10: Short Versus Long Duration of Antibiotics in Penetrating Abdominal Trauma: A Meta-analysis of Randomized Controlled Trials

Objective: The objective of the study was to determine whether a short course (within 24 h) of antibiotics is as effective as a long course (5 days) in preventing operative surgical site infection in patients with penetrating abdominal injury. In addition, the secondary outcome is to examine the effect of antibiotic duration on the mortality rate. Data Source: A comprehensive search of electronic databases (PubMed and Embase) until January 2024 comparing a short course (within 24 h) versus a long course (5 days) of antibiotics in preventing postoperative surgical site infection. Study Selection: Inclusion criteria were English-only studies, and the type of studies was restricted to randomized controlled trials. Data Extraction: Two authors independently extracted data from the selected studies, and the data collected were compared to verify agreement. Data Synthesis: Postoperative surgical site infection in patients with penetrating abdominal trauma was the primary outcome evaluated in each study. Studies were weighed by the inverse of the variance of the outcome, and a fixed-effects model was used for all analyses. Conclusion: Based on the available literature on the duration of antibiotics for penetrating abdominal injury with or without associated hollow viscus injury, it can be concluded that a short-course antibiotic (within 24 h) is as effective as a longer course (5 days) to be given for a patient with penetrating abdominal injury to prevent postoperative surgical site infection.

562 Midline Versus Off Midline Extraction Site in Laparoscopic Left Sided Colorectal Resections for Colorectal Malignancy: A Systematic Review and Meta-Analysis

Abstract Method To evaluate comparative outcomes of off-midline and midline extraction sites in laparoscopic left sided colorectal resections. Method A systematic search of electronic databases and bibliographic reference lists was conducted, and a combination of free text and controlled vocabulary search was adapted to thesaurus headings, search operators and limits in electronic databases were applied. Studies comparing the outcomes of Off Midline and Midline incisions for specimen extraction in laparoscopic left sided colorectal resections were included. Incisional hernias, surgical site infections, operative time, estimated blood loss, anastomotic leak and length of hospital stay were the evaluated outcome parameters. Results We identified 5 comparative studies reporting a total of 1187 patients comparing outcomes of off-midline (n=486) and midline (n=701) incisions for specimen extraction in laparoscopic left colorectal resections. The off-midline approach was associated with lower post operative surgical site infection (OR 0.71, P=0.68), anastomotic leak (OR 0.76,P=0.66), and incisional hernia (MD: 0.65,P=0.64) compared to midline approach, however it was not statistically significant. There was no significant difference in operative time (MD: 0.10, P=0.99), intra-operative blood loss (MD 2.31, P=0.91), and post-operative hospital stay (MD : 0.78, P=0.18) between the two groups. Conclusions Off-midline extraction site for left sided colorectal resections have no significant difference in rates of post operative surgical site infection and incisional hernias when compared to midline extraction site. No significant difference was found in operative time, intra-operative blood loss, anastomotic leak and post operative hospital stay in this study. Future higher-level research is required to further evaluate the clinical outcomes.

Is Childhood Intussusception Seasonal? A Single Center Experience

Background: The incidence of intussusception may vary from one season to another and from one country to another. The aim of this study was to evaluate the seasonality of childhood intussusception. Materials and Methods: This was a retrospective study of infants, aged one year and below, who presented with intussusception (ultrasound confirmed) between January 2016 and December 2020 at the pediatric surgery unit of Enugu State University Teaching Hospital (ESUTH) Enugu, Nigeria. Results: A total of 378 cases of intussusception in infants were seen during the study period. There were 236 (62.4%) and 142 (37.6%) females. The median age of the patients was 6 months with a range of 3 to 12 months. Abdominal pain was the most common presenting symptom and most of the intussusceptions occurred during the dry season. Majority of the patients had operative treatment and surgical site infection was the most common postoperative complication. The overall outcome was good. However, 34 (9%) infants expired. Conclusion: Although intussusception can occur at any time of the year, this study has shown that more cases of intussusception are seen during the dry season in our centre. This spans over a period of October to March.

TO STUDY THE OUTCOME OF PATIENT UNDERGOING ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY WITH SINGLE DOSE OF ANTIMICROBIAL PROPHYLAXIS.

INTRODUCTION :- Laparoscopic cholecystectomy is very commonly performed surgery for symptomatic cholelithiasis. There is very low risk of infective complications in elective Laparoscopic cholecystectomy and hence standard guideline doesn't recommend prophylactic antibiotic usage for low risk cases. However it is very commonly practicised in dosage and duration inconsistent among various surgeons. This study is being done to assess the efcacy of single dose antibiotic prophylaxis over multiple dose in the prevention of surgical site infection in patients undergoing elective laparoscopic cholecystectomy to avoid antibiotic resistance and overuse of it . METHODS: The study included 60 patients admitted for elective Laparoscopic cholecystectomy. First 30 patients received injectable ceftriaxone 1 gram intravenous peri-operatively, rst dose twelve hour before surgery and second dose half hour before surgical incision and then followed by injection (conventional dose) ceftriaxone 1 gram/day iv twice daily for the rst 5-7 days post-operatively. Next 30 was dened as the single dose (post-operative) antibiotic patients , this group were given only single dosage of injectable ceftriaxone 1 gram intravenous post-operatively.operation-room anesthetic assistant administered prophylactic antibiotics at induction of anaesthesia to all the patients. On the third, fth, tenth and fteenth days post operatively, based on Southampton scoring system the wound was seen and grading of the infection was done RESULT: The post-operative surgical site infection rate in group receiving single dose was 7.76 % and that in multiple dose group was found to be 6.67% . Chi- square test was used to analyse the data and the difference in the rate of SSI in both the groups was found to be statistically insignicant. CONCLUSION: There is no signicant difference in the outcome of elective laparoscopic cholecystectomy in terms of post operative surgical site infection in single dose and multiple dose group. Also single dose of antibiotics are more patient compliant, cost effective, have less adverse effects and reduce the incidence of antibiotic resistance

Vancomycin Powder Associated with Decreased Surgical Site Infections in Lower Extremity Trauma

Category:Ankle; Ankle Arthritis; Arthroscopy; Bunion; Hindfoot; Midfoot/Forefoot; Sports; TraumaIntroduction/Purpose:The use of intraoperative topical vancomycin powder has recently increased in popularity as a method of theoretically decreasing post-operative surgical site infections; however, there is limited research in orthopaedic trauma to support its use. This study evaluates the use of topical vancomycin powder to decrease post-operative infections following lower extremity trauma. We also investigated socio-demographic factors and medical comorbidities that were associated with post- operative surgical site infections.Methods:We conducted a review of 226 patients at a single Level 1 Trauma Center following surgery between the years 2015 and 2020. These patients were treated predominantly by a single fellowship trained foot and ankle orthopaedic surgeon. Demographic factors, medical comorbidities, postoperative infections, and use of vancomycin powder were reviewed. Analysis of 4 groups (no infection, superficial infection, deep infection, or both) was performed using Fischer's exact test and Student t-test. A logistic regression model was utilized to identify independent demographic factors and medical comorbidities that were associated with surgical site infection.Results:The final cohort included 221 patients, of which 26 received intraoperative vancomycin powder. There were 23 total post-operative surgical site infections. Of those, 14 infections were superficial, 3 were deep, and 6 were both superficial and deep. All but one of these infections were in patients without vancomycin powder applied. Patients who received intraoperative vancomycin powder were statistically significantly less likely to acquire post-operative surgical site infections than those who did not (1 vs. 22, p=0.031). The one postsurgical site infection with vancomycin use was a deep infection in a patient with chronic kidney disease that had previously undergone three irrigation and debridement surgeries for a gunshot wound. Male sex was the only demographic or comorbidity factor associated with postoperative surgical site infection (p=0.009, OR=4.006).Conclusion:We found an association between topical vancomycin use and lower likelihood of developing postsurgical wound infections in lower extremity trauma. This is consistent with similar studies in spinal surgery. In contrast to previous studies, we did not find a significant association between medical comorbidities or demographic factors other than male sex and surgical site infection. Future studies should aim to identify which patients would have the greatest reduction of risk for postsurgical wound infections with the use of intraoperative topical vancomycin powder.

Machine Learning to Predict Fascial Dehiscence after Exploratory Laparotomy Surgery

Fascial dehiscence following exploratory laparotomy is associated with significant morbidity and increased mortality. Previously published risk prediction models for fascial dehiscence are dated and limit a surgeon's ability to perform reliable risk assessment intraoperatively. We sought to determine if machine learning can predict fascial dehiscence after exploratory laparotomy. A retrospective cohort study was conducted of 93,024 patients undergoing exploratory laparotomy from the 2011-2018 ACS NSQIP data files. Data were divided into training (2011-2016, n=69,969) and temporal validation (2017-2018, n=23,055) cohorts. A clinical decision support tool was developed using the model generated via machine learning techniques. 1,332 (1.9%) patients in the training cohort and 390 (1.7%) patients in the temporal validation cohort developed fascial dehiscence. The area under the receiver operating characteristic curve was 0.69 (95% CI 0.66 to 0.72) in the validation cohort. Model predictions demonstrated excellent probability calibration. Decision curve analysis calculates net clinical benefit within a threshold range of 0.8%-4.5%. Operative time, surgical site and deep space infections, and body mass index were among the most important features for model predictions. Finally, operative time, sodium level, and hematocrit demonstrated non-linear relationships with predicted risk. A clinical decision support tool for predicting fascial dehiscence after exploratory laparotomy was created and validated on a contemporary, national patient cohort using machine learning. The tool calculates net clinical benefit and can be used at the point of care. Some identified risk factor relationships were found to be complex and non-linear, highlighting the ability of some machine learning applications to capture nuanced, patient-specific risk profiles.

A Retrospective Study of Bacteriology and Antibiotic Sensitivity Pattern of Post Operative Surgical Site Infections in Orthopedics

Surgical Site infection (SSI) is one of the most common post-operative complications and causes significant post-operative morbidity and mortality. The global estimates of SSI have varied from 0.5% to 15%, studies in India have consistently shown higher rates ranging from 23% to 38%1. The aim of the study was to know the etiological bacterial agents causing SSI and their antimicrobial susceptibility pattern. This retrospective study included 69 patients who developed Post-operative wound infections (SSI) during the 1-year period from April 2019 to March 2020. An analysis of SSI occurrence, the organisms isolated and antibiotic sensitivity pattern results was made. In overall surgeries conducted during the study period in orthopedics department at our institute, 69 cases were clinically diagnosed of having SSIs, including 51 males and 18 females with the mean age of 39.2 years. Out of the total 69 samples, 6 (8.69%) yielded no bacterial growth and among the rest 63 samples, Staphylococcus aureus 21 (30.43%) was the most common organism isolated. The other organisms isolated were Klebsiella pneumonia 13 (18.84%), Pseudomonas 11 (15.94%), Escherichia coli 5 (7.24%), Proteus species 3 (4.34%) and Acinetobacter species 3 (4.34%). Mixed isolates were obtained in 2 (11.9%) specimens. Bacteriological and antibiotic susceptibility study is an important tool to treat infection timely and effectively in-turn minimizing untoward long term sequelae of surgical site infections.

A comparative study of subcutaneous negative pressure versus simple closure of skin incision following surgery for hollow viscus perforation

Background: Surgical site infection (SSI) is a significant problem associated with open abdominal surgery resulting in increased morbidity, mortality, and cost of treatment. Surgical site infection is one of the most common post-operative complications, occurring in at least 5% of all patients undergoing surgery and 30-40% of patients undergoing abdominal surgery, depending on the level of contamination. This study compares the subcutaneous single closed suction drain and simple conventional closure of skin incision in emergency laparotomy for hollow viscus perforation.Aim: The aim of the study is to determine whether the insertion of a subcutaneous closed suction drain at the incisional site reduces the incidence of post-operative surgical site infection in emergency laparotomy for hollow viscus perforation.Methodology: This is a prospective study. Fifty patients was enrolled, Patients diagnosed to have acute abdomen clinically and radiologically were planned for emergency exploratory laparotomy. They were further allocated alternately to Group I with subcutaneous closed suction drain and Group II without drain. All the patients underwent laparotomy. Postoperatively wound complications and hospital stay was recorded.Conclusion: Our study shows that subcutaneous negative pressure drainage significantly reduces the post- operative surgical site infection and duration of hospital stay following surgery for hollow viscus perforation. This helps in early recovery, better wound healing, and decreases the financial burden on patients by decreasing hospital stay and infection. As post-operative complications depend on the level of contamination, we recommend use of closed negative pressure subcutaneous drain in all patients with contaminated or dirty wounds.

Pharmacological evaluation of prophylactic anti-microbial use in laparoscopic cholecystectomy; an open labelled study evaluating theconcentrations of single dose intravenous ceftriaxone at serum and tissue level.

The goal of administering preoperative systemic prophylactic antibiotics is to have the concentration in the tissues at its optimum level at the start and throughout the surgery. The rationale for the use of antibiotics is not well accepted; possible side effects and development of microbial resistance patterns are potential risks along with the financial burden. Therefore, the present study was conducted with the aim to clinically evaluate the serum and tissue concentration of single-dose prophylactic ceftriaxone during an ongoing laparoscopic cholecystectomy (LC) and to find out risk factors for post operative surgical site infections (SSI). It was an open labelled prospective study in 50 consecutive patients who underwent elective laparoscopic cholecystectomy under prophylactic cover of ceftriaxone. Serum and tissue concentration were estimated by HighPerformanceLiquidChromatography during the ongoing surgery. Subjects were observed for any post-operative complications including SSI. Serum and tissue concentrations of ceftriaxone were significant at test value of 4milligrams/Litre. Body mass index was significantly correlated with the tissue concentration of ceftriaxone at the time of incision. The rate of SSI was 2%. It significantly correlated with age more than 60years, diabetes and infected bile. A single prophylactic intra-venous dose of 1g ceftriaxone immediately prior to skin incision in LC is good enough for prevention of SSI in Indian patients.

Endogenous methicillin resistant staphylococcus aureus as a source of post-operative surgical site infections.

To determine frequency of Endogenous Methicillin Resistant Staphylococcus aureus (MRSA) in pre-operative patients and its frequency in Surgical Site Infections (SSIs) post operatively. It was a descriptive cross sectional conducted at Department of Microbiology, Fauji Foundation Hospital Rawalpindi (FFH), Pakistan. Samples were collected from 1st November-31st May 2018. Total 75 samples were collected during the period. Consecutive non-probability sampling technique was utilized. Specimens were collected from nose, axilla and groin of preoperative patients. Methicillin Resistant Staphylococcus aureus was identified if only isolated from these sites. Patients were followed till his/her discharge from the hospital and if they developed infection post operatively, pus specimen from infected site was also collected and identified. Out of 75 specimen preoperatively, 11(14.7%) were identified as endogenous MRSA. From these, 33(44%) developed Surgical site infections (SSIs), among them 19(57%) were MRSA (09 endogenous, 10 exogenous), 7(21.2%) were Escherichia coli, 3(9.1%) were Klebsiella pneumoniae, 3(9.1%) were Enterococcus faecalis and 1(3%) was Methicillin Sensitive Staphylococcus aureus. The results of this study determined that Endogenous Methicillin Resistant Staphylococcus aureus (MRSA) could be isolated from patients going for surgery if microbiological screening was done at the time of admission. This could prevent patients from Surgical Site Infection Post operatively by these endogenous MRSA. This search and wipe out strategy is able to curtail the events of outbreak, reduce hospital stay and decrease budget of the hospital by providing guidance in choice of empirical therapy for infection.

Incidence of post operative surgical site infection in thyroid surgery following single dose of prophylactic antibiotic

Surgical site infection after thyroid surgery is a less common incidence. Prophylactic antibiotic before surgery and empirical antibiotic therapy after surgery is a common practice in our country. But international guidelines do not suggest antibiotic in clean surgical procedure.&#x0D; Aim: To compare the incidence of surgical site infection after thyroid surgery with and without empirical antibiotic therapy.&#x0D; Method: It was a cross sectional study, done from July 2010 to December 2010 in 3 medical college hospitals in Dhaka city. Total 100 cases were included in this study, 50 cases for study in which only single prophylactic antibiotic used half an hour before operation, 50 cases for control in which 7 days antibiotic used per orally in addition to prophylaxis.&#x0D; Result: Among 100 cases male were 24 &amp; female 76 (M: F= 1:3.2). Oldest patient was 56 yrs &amp; youngest 21yrs. 47% patient operated for solitary thyroid nodule, 35% multinodular goiter &amp; only 6% diffuse goiter. 47% patient was done hemithyroidectomy &amp; only 7% total thyroidectomy. All the operations were completed within 2 hours where 40% within one hour. No surgical site infections were found in both study and control cases.&#x0D; Conclusion: There is no statistical difference between routine antibiotic use and no use of antibiotic after thyroid surgery.&#x0D; Bangladesh J Otorhinolaryngol; April 2016; 22(1): 15-20

Evaluation of risk factors for surgical site infection following abdominal surgeries

Objective:surgical site infections (SSIs) are substantial cause of morbidity and mortality among the hospitalized patients. The present study was performed to analyze the incidence of SSIs and to evaluate the risk factors for SSI following abdominal surgeries at a tertiary healthcare centre. Material & Methods: The present study is a prospective study carried out in the Department of general surgery, Dungarpur Medical College & Hospital, Rajasthan during the period of 1 year from January 2018 to January 2019. A total of 100 elective and emergency cases of abdominal surgeries were included in the study. Results: 76 patients were male and 24 were female. Age of the patients ranges from 15 to 70 years with the mean age of 52.2 years. Out of 100 procedures, 38 were emergencies and 62 were elective procedures. 11 cases of SSIs were encountered during the study period. Exploratory laparotomy was the surgery most commonly associated with SSIs (4 cases), followed by bowel resection (3 cases) and cholecystectomy (2 cases). Conclusion: Post -operative surgical site infections causes substantial increase in morbidity and mortality associated with the disease and also increase the healthcare cost. Meticulous surgical techniques, minimizing the duration of operation, proper sterilization, hygienic operation theatres and ward environments are few of the habits which can reduce the risk of SSIs.