Author(s): Rohini Muralidhar Gajbhiye, Sunita Raj Gajbhiye, Laxdip Madhukar Parekar
BACKGROUND Surgical site infections (SSIs) is the third most frequently reported nosocomial infection, accounting for 12% to 16% of all nosocomial infections among hospitalised patients, as reported by the National Nosocomial Infections Surveillance (NNIS) system. The Centre for Disease Control and Prevention (CDC) and NNIS have developed criteria for defining SSIs, which have become national standards and are widely used by surveillance and surgical personnel. These criteria define SSIs as “infections related to the operative procedure that occur at or near the surgical incision (incisional or organ/space) within 30 days of an operative procedure or within one year if an implant is left in place”. The estimates of the incidence of SSI are dependent upon voluntary self-reporting by surgeons, which is unreliable because most wound infections occur when the patient is discharged, and these infections may be treated in the community without hospital notification. Therefore, estimates of the prevalence of SSIs are almost underestimates, although the best data is available. Hence, present study was conducted so to estimate the prevalence of SSIs in tertiary care hospital in central Maharashtra. MATERIALS AND METHODS The study was carried out over a period of 2 years (2011-2013) in the Department of Microbiology, Indira Gandhi Government Medical College & Hospital, Nagpur, Maharashtra; around 19,127 patients were operated in different surgical departments and 517 (2.7%) patients developed SSIs. The patients who were clinically diagnosed as cases of SSIs were included in study (517). A detailed history of patients was taken, (including age, gender, date of admission, presence of past or current infection, duration of pre & post-op hospital stay, antibiotic prophylaxis received, emergency or elective type of surgery, type and duration of anaesthesia, major or minor surgery, condition of wound at time of first post-op dressing, class of wound, number of dressings done and antibiotics received after surgery, etc.). The surgical wound was inspected at the time of first dressing and two specimens were collected and processed as per standard microbiological techniques. RESULTS Around 19,127 cases underwent surgery in various surgical departments. Out of these patients, the rate of SSIs was found in 517 patients (2.7%). It was found to be highest among patients of age group of 31 to 40 years (25.53%) and in males (56.86%) as compared to females (43.13%). SSIs rate was highest in surgeries performed under emergency conditions (54.15%) and under general anaesthesia (47.19%). SSIs rates increased with increase in duration of surgeries (>4 hours -22.05%) & with prolonged history of pre- & post-operative hospital stay (28.43%). Out of 517 cases, 370 (71.56%) patients received AMP. Among various operative procedures, SSI was highest in surgeries for perforation peritonitis (11.99%) & LSCS (11.02%). SSIs rate was highest in deep surgical sites (49.51%) than in organ / space (40.81%) and superficial (9.67%) surgical sites. Also, the rate of SSIs in class IV (dirty) was highest (41.19%) than in class III (contaminated) (29.20%), class II (clean contaminated) (17.02%), and in class I (clean) type of wound (12.5%). Out of 517 samples collected, 340 samples showed growth and 177 showed no growth and 40 samples had mixed growth. The most frequently isolated organism was E. coli (23.33%), followed by A. baumannii (16%) and K. pneumoniae (15.66%). K. pneumoniae was found to be the commonest ESBL producer (40.62%) as well as AmpC producer (17.18%). While A. baumannii 18 (28.57%) was found to be the commonest MBL producer. The rate of MRSA was found to be (45%) and ICR was (17.5%). CONCLUSION Despite of all activities, SSIs remain a substantial cause of morbidity and mortality among hospitalized patients even in urban tertiary care centres. This may be partially explained by surgeons reporting the emergence of antimicrobial-resistant pathogens and the increased numbers of surgical patients who are elderly and/or have a wide variety of chronic, debilitating, or immunecompromising underlying diseases, etc. Besides these, antibiotics have potential impact on preventing mortality in developing countries. The use of antimicrobial prophylaxis for selected surgical procedures is one of the measures used to prevent the development of a surgical site infection. Also, other infection control practices include improved operating room ventilation, sterilization methods, barriers, surgical technique, and availability of antimicrobial prophylaxis.