Spectrum of surgical site infection on the surgical floor; Increasing resistance to routine antibiotics

  • Muhammad Iqbal BBH
  • Naveed Akhtar Malik
  • Muhammad Hanif
Keywords: SSI, anti biotic resistance

Abstract

Objective: To know the spectrum of surgical site infections in general surgical patients so that specific strategies can be developed to decrease the morbidity caused by these infections.
Material and Methods: All the patients who underwent general surgical operations on an emergency basis at the surgical unit of the District headquarters teaching hospital Rawalpindi from 01-01-2016 to 31-12-2017 were evaluated for surgical site infections. Surgical site infections suspected clinically were confirmed by culture and sensitivity. Involved flora and their sensitivity to various antibiotics were also determined.
Results: Among 2202 emergency operated patients, two hundred and thirty-seven patients (10.76%) had surgical site infection confirmed on culture and sensitivity (C/S) report. About sixty-five percent of patients were male. Of two hundred and thirty-seven positive patients, the twenty-nine patient underwent laparotomy for penetrating and blunt abdominal trauma. Staph aureus was present in one hundred and forty-five (79.67%) patients. E.coli was the commonest Gram-ve micro-organism (70.95%). Forty-six patients (19.40%) were sensitive to Cefoperazone sodium followed by twenty patients (8.43%) to Piperacillin sodium and twenty-one (8.86%) each to Amikacin and Linezolid.
Conclusion: Surgical site infection causes a significant rise in morbidity on the surgical floor. Most of the causative microorganisms are becoming resistant to routine antibiotics. Sensitivity to the broader spectrum of antibiotics like Cefoperazone and Linezolid is increasing.

References

1. Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. Journal of hospital infection. 2008 Nov 1;70:3-10. https://doi.org/10.1016/S0195-6701(08)60017-1
2. Sachin P, Mitesh P, Sangeeta P, Sumeeta S, Dipa K, Mahendra V. SURGICAL SITE INFECTIONS:INCIDENCE AND RISKFACTORS IN A TERTIARY CARE HOSPITAL, WESTERN INDIA National Journal of Community Medicine.2012: 3 (2).
3. Üstün C, Geyık MF, Aldemır M, Tekin R, Çelen MK, Gırgın S, et al. Surveillance of Nosocomial Infections in General Surgery Unit: Data of Ten Years Period. Duzce Medical Journal. 2010 Sep 1;12(3).
4. Anvikar A.R., Deshmukh A.B., Karyakarte R.P., Damle A.S., Patwardhan N.S., Malik A.K., et al. A one year prospective study of 3280 surgical wounds. Indian J Medical Microbiology 1999; 17(3):129-132.
5. Watanabe A, Yamanaka T, Baba H, Higashi H, Orita H, Emi Y. Risk factors associated with surgical site infection in upper and lower gastrointestinal surgery. Surgery Today, May 2008: 38 (5),404-412.
6. Lilani SP, Jangale N, Chowdhary A, Daver GB. Surgical site infection in clean and clean-contaminated cases. Indian J Medical Microbiology 2005; 23(4):249-252
7. Cruse PJE. Classification of operations and audit of infection. In: Taylor EW, editor. Infection in Surgical Practice. Oxford: Oxford University Press, 1992; 1-7.
8. Kropec A, Huebner J, Riffel M, Bayer U, Benzing A, Geiger K, et al. Exogenous or endogenous reservoirs of nosocomial Pseudomonas aeruginosa and Staphylococcus aureus infections in a surgical intensive care unit. Intensive care medicine. 1993 Mar;19(3):161-5. https://doi.org/10.1007/BF01720533
9. Rolston K, Mihu C, Tarrand J. Current microbiology of surgical site infections associated with breast cancer surgery. Wounds. 2010 May; 22(5):132-5.
10. Naik, G. and Deshpande, S.R. A study on surgical site infections caused by staphylococcus aureus with a special search for methicillin-resistant isolates Journal of Clinical and Diagnostic Research. 2011; 5(3): 502-508.
11. Adegoke, A., Mvuyo, T., Okoh, A.I., Steve, J. Studies on multiple antibiotic resistant bacteria isolated from surgical site infection Scientific Research and Essays. 2010; 5(24): 3876-3881.
12. Hagel S, Scheuerlein H. Perioperative Antibiotic Prophylaxis and Antimicrobial Therapy of Intra-Abdominal Infections...Viszeralmedizin.2014 Oct;30(5):310-6
13. Ali M, Nadeem M, Shah SZ, Ullah MA. Prolonged versus short course of antibiotic prophylaxis in clean general surgery. Journal Of Medical Sciences. 2012 Aug 1;20(3):128-32.
14. Phillips AW, Cranfield KJ, Horgan AF. MRSA infections following colorectal surgery in an enhanced recovery programme. Colorectal Disease. 2013 Jan;15(1):97-101. https://doi.org/10.1111/j.1463-1318.2012.03109.x
15. Jan N, Abbas Z, Ahmed MN, Tandon VR, Imran M, Parveen S, et al. Prospective randomized open labeled study comparing prophylactic efficacy of parenteral single dose cefuroxime vs ampicillin-sulbactam in patients undergoing elective cholecystectomy. JK Science. 2012 Apr 1;14(2):77.
16. Leaper DJ, van Goor H, Reilly J, Petrosillo N, Geiss HK, Torres AJ, et al. Surgical site infection – a European perspective of incidence and economic burden. Int Wounds Journal 2004; 1(4): 247-273.
17. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999 Apr;27(2):97-132
18. Cruse P. Wound infection surveillance. Rev Infect Dis. 1981; 3(4):734–737.
19. Hafeez A, Munir T, Najeeb S, Rehman S, Gilani M, Ansari M, et al. ICU pathogens: a continuous challenge. J Coll Physicians Surg Pak. 2016 Jul 1;26(7):577-80.
20. Healthcare risk management review HRMR, 60% Men at higher risk from surgical site infections; 24-07-2013
21. Shahane V, Bhawal S, Lele MU. Surgical site infections: A one year prospective study in a tertiary care center. International journal of health sciences. 2012 Jan;6(1):79.
22. Kaye1 KS, Schmit K, Pieper C, Sloane R, Caughlan KF, Sexton DJ, et al. The Effect of Increasing Age on the Risk of Surgical Site Infection J Infect Dis. (2005) 191 (7): 1056-1062.
23. Chapter IV Factors Influencing the Incidence of Wound Infection. Ann Surg. 1964; 160 (2):32-81.
24. Prospero E, Cavicchi A, Bacelli S, Barbadoro P, Tantucci L, D’Errico MM. Surveillance for surgical site infection after hospital discharge: a surgical procedure-specific perspective. Infect Control Hosp Epidemiol. 2006; 27(12):1313–1317.
25. Bowler PG, Duerden BI, Armstrong DG. Wound microbiology and associated approaches to wound management. Clinical microbiology reviews. 2001 Apr 1;14(2):244-69.
26. Chambers D, Worthy G, Myers L, Weatherly H, Elliott R, Hawkins N, et al. Glycopeptide vs. non-glycopeptide antibiotics for prophylaxis of surgical site infections: a systematic review. Surgical infections. 2010 Oct 1;11(5):455-62. https://doi.org/10.1089/sur.2009.055
27. Anderson DJ1, Kaye KS. Staphylococcal surgical site infections Infect Dis Clin North Am. 2009 Mar;23(1):53-72
28. Madappa T, Bronze MS. Escherichia Coli Infections. Updated: Jan 11, 2016
29. Kamath N, Swaminathan R, Sonawane J, Bharos N. Bacteriological profile of surgical site infections in a tertiary care center in Navi Mumbai. Proceedings of the 16th Maharashtra Chapter Conference of IAMM, Karad, Maharashtra. 2010 Sept 24–26;. P 6
30. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. Journal of Hospital Infection.2014; 86( 1): 24
31. Centre for disease control and prevention. CDC 24/7; saving lives, protecting people.
32. Ashley ED, Carroll DN, Engemann JJ, Harris AD, Fowler Jr VG, Sexton DJ, et al. Risk factors for postoperative mediastinitis due to methicillin-resistant Staphylococcus aureus. Clinical infectious diseases. 2004 Jun 1;38(11):1555-60. https://doi.org/10.1086/420819
33. Moore M. What’s the best antibiotic for MRSA? Posted on December 29, 2012
34. Marin H. Limitations of Vancomycin in the Management of Resistant Staphylococus Infections. Clin Infect Dis. 2007; 45 (3): 191-195.
35. Wang J, Pan Y, Shen J, Xu Y. The efficacy and safety of tigecycline for the treatment of bloodstream infections: a systematic review and meta-analysis. Annals of clinical microbiology and antimicrobials. 2017 Dec;16(1):1-0. https://doi.org/10.1186/s12941-017-0199-8
Published
2021-06-30
How to Cite
1.
Iqbal M, Malik N, Hanif M. Spectrum of surgical site infection on the surgical floor; Increasing resistance to routine antibiotics. JRMC [Internet]. 30Jun.2021 [cited 4Dec.2021];25(2):258-63. Available from: http://www.journalrmc.com/index.php/JRMC/article/view/1600
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