A comparative study to determine the role of pre and post-operative antibiotic therapy versus only pre-operative antibiotic therapy in patients of non-perforated acute appendicitis

Background: If properly used in appendicitis, antibiotics can reduce the rate of infection by 50%. The use of post-operative antibiotics for preventing infective complications in non-perforated cases is still controversial.Methods: A randomised prospective study was conducted in the Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi with patients who presented acute appendicitis. A minimum number of 30 patients each in group A (pre-operative and post-operative antibiotics) and group B (only pre-operative antibiotics) were evaluated for 18 months, from January 2018 to June 2019.Results: The mean age of group A is 29.9±15.16 years and in group B is 25.97±9.470 years (p value=0.122, insignificant). There was male preponderance. The seroma formation in both the groups was 10.00% and no patients developed intra-abdominal abscess. The incidence of local site oedema was 10% in both the groups A and B and their p value is insignificant. In both the groups A and B, 10% of the people developed pus discharge from the stitch line and the p value is insignificant. In group A, 6.67% of the patients and in group B 10.00% of the patients developed stitch line inflammatory changes and the p value insignificant. In group A, 13.3% and in group B, 10.00% of the patients developed fever and their p value is 1. The mean length of hospital in case 1.23±0.5 days (group A) and is 1.17±0.45 days (group B) (p value=0.508).Conclusions: Hence we can conclude that a well-chosen and adequately-timed pre-operative antibiotics are adequate in preventing post-operative complications and post-operative antibiotics do not affect the same.

Incidence of incisional hernia with respect to different sites and causes

Background: Of all hernias encountered, incisional hernias can be the most frustrating and difficult to treat. The aim of this study is to find out the incidence of incisional hernia at different sites and to find out their possible causes.Methods: This was a prospective study of 50 cases of Incisional hernias admitted during the period between July 2017 to July 2019. Collected data is analysed over a period of 3 months. Patients with Incisional hernia satisfying the inclusion criteria, attending surgery OPD at Dr. D. Y. Patil Medical College, Pimpri, Pune were included in study group.Results: Mean age at presentation was 45 (32/50) were female 18 patients were male. Majority of the patients were obese. Infra-umbilical variety of incisional hernia is most common 42%. The most common primary surgery is tubal ligation was 14 (28%). Significant association noted between diabetes mellitus and SSI, p value <0.05. There is a significant association between addictions (tobacco, smoking and alcohol) and hernias in umbilical region and above p value <0.005.Conclusions: The incidence of incisional hernia is more in multiparous females. Infra-umbilical midline was the most common site for herniation in 42% of cases. Lower midline incisions are more prone for herniation as the posterior rectus sheath is deficient below arcuate line. The most common previous surgery was tubectomy 14. Diabetes and SSI played important role in causing incisional hernia in our study.

Effectiveness of bundled interventions in reducing surgical site infections in elective caesarean sections and caesarean hysterectomies in a tertiary care centre

Background: Surgical site infections are the most common and easily preventable infections complicating surgeries. CDC recommends certain bundle interventions for the prevention of SSIs. Hence the present study was undertaken to see the effectiveness and feasibility of the bundle interventions in the elective caesarean sections and caesarean hysterectomies.Methods: A total of 600 patients were taken. Bundled interventions were applied in 278 caesarean sections and 26 caesarean hysterectomies. Routine care was implemented in 262 caesarean sections and 34 caesarean hysterectomies. Rate of SSI, risk factors associated and treatment outcomes were studied.Results: 8 out of 304 cases of the bundled intervention group developed SSI, giving a rate of 2.6%. 52 cases out of 296 in the routine care group developed SSI, the SSI rate being 17.5%. Anemia and diabetes were the most common risk factors.Conclusions: Adherence to bundled interventions can significantly and easily reduce the incidence of SSI.

Prevalence of surgical site infections and their sensitivity patterns in elective abdominal surgeries in King George Hospital, Visakhapatnam

Background: Surgical site infections are one of the most common complications in the postoperative period leading to increased morbidity, prolonged hospital stay and reduced quality of life. The present study aims to identify the incidence of surgical site infection (SSI), risk factors, causative organisms, and their sensitivity patterns in patients who have undergone elective abdominal surgeries.Methods: A prospective study containing 200 patients who have undergone elective abdominal surgeries from May 2018 to January 2020 were evaluated. A thorough history was taken in all the patients. A detailed clinical examination and routine investigations were done. Parameters such as body mass index (BMI), diabetic status, type of surgery, wound grading, culture, and sensitivity patterns were considered. The patients underwent treatment based on their investigatory reports.Results: In the present study, 54 patients developed surgical site infection, and among them, 22 are diabetics. Only ten patients with normal BMI developed SSI, whereas the other 44 patients who developed SSI had abnormal BMI. The incidence of SSI was higher in clean-contaminated surgeries comprising up to 89% of cases. Staphylococcus aureus was the most commonly isolated organism, and cefoperazone plus sulbactam was the most sensitive on antibiogram.Conclusions: The surgical site infections are on rising trend due to the emergence of antibiotic-resistant microorganisms. Treatment of the underlying risk factors, regular wound dressings, and antibiotics, according to sensitivity patterns, are the mainstay.

Role of probiotics on surgical site infections in colorectal surgery

Background: Elective colorectal procedures are well known for their high rates of surgical site infections (SSI). Perioperative stabilization of microflora is a potential alternative. Usage of probiotics has significantly improved intestinal microflora and reduced infectious complications and improved surgical outcome.Methods: Observational follow-up study on 100 patients. Probiotics were given along with standard preoperative protocol and development of SSI was inspected upto 30 days. The data thus collected was subjected to descriptive analysis.Results: Colorectal malignancy was the most common indication out of which carcinoma rectum was most common comprising of 40% of the total subjects. Mean days to passage of first flatus was 3.13±1.33 days. Mean days to passage of first defecation was 4.6±1.64 days. Mean days to first solid diet was 4.42±2.02 days. Mean duration of total length of hospital stay was 14.7±8.7 days. Surgical site infections were seen in 17% of the participants of the study. Urinary tract infections were seen in 2 (2%) patients. Lower respiratory tract infections were seen in 2 (2%) patients. Anastomotic leak was present in 2 cases (2.8%) out of 70 cases. Mortality was seen in 2 (2%) cases.Conclusions: Perioperative usage of probiotics can lead to decrease in incidence of infectious complications but cannot be statistically proved due to insufficient data. Also due to early bowel functioning there is decrease in the mean hospital stay which contributed to better surgical outcome and better quality of life.

A Point Prevalence Survey of Antimicrobial Usage for Surgical Site Infections- A Pilot Perspective from Holy Makkah, Saudi Arabia

Introduction:This study aimed to assess the incidence, microbiological features and management of surgical site infections (SSIs). Methodology:All patients in the surgical ward were followed from admissions until discharge during the study period. Only hospitalized patients with certain SSIs within 30 days of surgeries were included in the study. Results:A total of 457 patients were followed during the study period. Interestingly, only 9 (1.9 %) of the patients developed SSIs. Most of the patients were males 6 (66.7%) and Saudi nationals 7 (77.8 %). The most common surgical procedures were laparoscopic and orthopedic surgeries with a similar rate of 3 (3.3 %).Conclusion:This study revealed that the incidence of SSIswas quite lower atthe hospital where the study was conducted and different types of antibiotics were used and recommended for prophylaxis

Comparison of efficacy of large tissue bites versus small tissue bites for midline abdominal wound closure

Background: Incisional hernia is common complication after median laparotomy, with reported incidence varying between 2% and 20%. For prevention of incisional hernia, many clinical trials and meta-analyses have demonstrated that mass closure technique with simple running suture is good option to close midline incision. An attempt was made in this study to compare efficacy of large tissue bites vs small tissue bites for midline abdominal wound closure.Methods: Three hundred thirty patients admitted for midline laparotomy were randomized into Group A, and Group B. Group A, and Group B patients underwent abdominal closure by small bites technique, and large bites technique respectively. Patients were followed at 7th postoperative day, 1 month, 6 months, and 12 months. Primary outcome measures were incidence of incisional hernia, incidence of postoperative complications like post-operative pain, surgical site infections, wound dehiscence whereas, secondary outcome measure was fascial closure time. Inter-group comparison of categorical, and continuous variables was done using Chi-square test/Fisher’s exact test and unpaired ‘t’ test respectively.Results: Incidence of incisional hernia was significantly higher in large bites suture technique compared to small bites suture technique at 12 months follow up. Mean time required for fascial closure time was significantly higher in small bite group compared to large bite group. There was no statistically significant difference in postoperative pain, surgical site infections, and wound dehiscence among the two groups.Conclusions: The rate of incisional hernia was lower in small bites technique compared with large bites technique in midline abdominal incisions.

Impacto del uso de anillos y uñas esmaltadas en la calidad de la higiene de manos en el personal de salud / Impact of the use of rings and nail polish on hand hygiene quality in healthcare workers

Resumen Introducción: Las infecciones asociadas a la atención de salud son un problema frecuente en el ambiente hospitalario. La higiene de manos es la medida más efectiva para su prevención. El uso de ciertos accesorios en las manos podría disminuir su efectividad y favorecer la transmisión horizontal de agentes infecciosos. Objetivo: Revisar los estudios publicados que evalúan el impacto del uso de anillos y uñas esmaltadas en la calidad de la higiene de manos en trabajadores de la salud. Métodos: Búsqueda no sistemática en base de datos PUBMED/MEDLINE (1978-2018) de estudios en los cuales se mide la calidad de la higiene de manos o lavado quirúrgico, mediante cultivos cuantitativos o tinciones fluorescentes. Resultados: Uso de anillos: Trece de 51 artículos cumplían los criterios de inclusión. Siete fueron realizados en unidades clínicas, y en todos ellos éste se asoció a menor calidad de la higiene de manos (la mayoría de baja calidad). Contrariamente, en tres de cuatro estudios primarios realizados en pabellón (de baja calidad), su uso no impactó en la calidad del lavado quirúrgico. Igualmente, dos revisiones sistemáticas obtuvieron similares conclusiones. Uñas esmaltadas: siete de 54 artículos fueron incluidos. En cuatro hubo resultados discordantes (la mayoría de baja calidad). En un estudio controlado se observó reducción en la calidad del lavado quirúrgico sólo cuando el esmalte estaba dañado. El esmalte gel se asoció a menor calidad de la higiene de manos en dos estudios experimentales. Conclusiones: No existe evidencia de calidad suficiente para asociar el uso de estos accesorios con reducción en la calidad de la higiene de manos. Tampoco queda demostrada su inocuidad. En base a la evidencia disponible (la mayoría de baja calidad), se observó un impacto negativo del uso de anillos en unidades clínicas y también de uñas con esmalte dañado en pabellones quirúrgicos. Se requieren estudios de mejor calidad para abordar estos relevantes tópicos.

Abstract Background: Health-care-associated infections are a frequent problem in hospital environments. Hand hygiene is the most effective measure to prevent outbreaks. The use of certain accessories could decrease its effectiveness, facilitating horizontal transmission of pathogens. Objective: Analyze the evidence that assess the impact of the use of rings and nail polish on hand hygiene quality in healthcare workers. Methods: Non-systematic search in PUBMED/MEDLINE database (1978-2018) of studies in which the quality of hand hygiene or surgical washing is measured, using quantitative cultures or fluorescent stains. Results: Wearing rings: 13 studies met the inclusion criteria. Seven were carried out in general wards. In all of them the use of rings was associated with lower quality of hand hygiene (the majority of low quality). Contrarily, in 3 of 4 primary studies carried out in the operating rooms (of low quality), their use did not affect the quality of surgical washing. Similarly, two systematic reviews obtained similar conclusions. Nail polish: 7 of 54 studies met the inclusion criteria. In four of them there were discordant results (the majority of low quality). One RCT showed a reduction in the quality of surgical washing only when the nail polish was damaged. Gel nail polish was associated with lower quality in two experimental studies. Conclusions: There is insufficient evidence to associate the use of these accessories with the reduction in the quality of hand hygiene. Its safety was not proven neither. Based on the available evidence (the majority of low quality), a negative impact of the use of rings in clinical units and also of damaged nail polish in operating rooms was observed. Better quality studies are required to address these relevant issues.

A study of pattern of pathogen and their sensitivity isolated from surgical site infections in abdominal surgeries

Background: Surgical site infection (SSI) is defined as those infections presenting up to 30 days after a surgical procedure if no prosthetic is placed and up to 1 year if prosthesis is implanted in the patient. SSI contributes to increasing morbidity, mortality and cost related to surgeries and continues to be a major problem even in tertiary care modern hospitals following standard protocols of peri operative preparation and antibiotics prophylaxis. Objective of this study was to study and analyse the pattern of pathogen causing SSI in abdominal surgeries in a tertiary care hospital.Methods: Descriptive study on patients undergoing abdominal surgery in the department of surgery. Patients satisfying inclusion criteria will be assessed on 2nd postoperative day and then daily for surgical site pain, redness, warmth, discharge and swelling of surgical site till the patient gets discharged and followed up after discharge every 7 days up to 1 month. If SSI is detected, swab will be taken and sent for culture and sensitivity.Results: At the end of the study, after analysing the pattern of pathogens and antibiotic susceptibility, we intend to conclude the safe usage of empirical antibiotic prophylaxis to prevent the incidence of SSI’s in our hospital.Conclusions: Appropriate prophylactic therapy for any open abdomen surgeries reduces incidence of surgical site infection thereby reducing morbidity, mortality and cost burden in patients undergoing abdominal surgeries.

Antibiotics sensitivity status and antibiogram patterns of aerobic bacterial isolates from surgical site infections

Background: Surgical Site Infections (SSIs) are the third most common nosocomial infections. Emergence and spread of drug resistant strains have been found to pose a serious challenge in the management of such infections. There is limited information on the epidemiology of such pathogens. The antibiotic sensitivity patterns of aerobic bacterial isolates from post-operative SSIs show wide variations that lead to difficulties in empirical selection of the right kind of drug for treatment. Properly planned studies about antibiotic sensitivities patterns of such isolates can help in judicious management of SSIs and cause reduction in morbidity and mortality.Methods: A total of 50 patients diagnosed by the surgeon and fulfilling the case definition of SSI, were studied for bacteriological analysis. All the clinical specimens were cultured and identified applying standard culture techniques. The aerobic bacterial isolates were subjected to antimicrobial susceptibility testing by Kirby Bauer Disc Diffusion method to arrive at the drug sensitivity patterns. Data were entered in MS Excel spread sheet and analysed using SSPP software version 21.00Results: A total of 32 patterns of sensitivity were observed. For Esch. coli, a total of nine patterns were observed. All strains of Esch. coli were found sensitive to tigecycline (100%) and colistin (100%). For Klebsiella spp. a total of 9 patterns were obtained with TIG-COL being the predominant pattern in 6 cases. For Acinetobacter spp. only colistin was found most effective drug. In case of Pseudomonas aeruginosa, except colistin (100% sensitivity), there were wide variations in sensitivity with imipenem (71%) as next most effective drug. In Proteus spp. - most of the in-use drugs were effective except cephalosporins. Among gram positive organisms, only three strains of Staphylococcus aureus were isolated, and these were MRSA (100%). Two strains of enterococcus were isolated, and these showed sensitivity to linezolid only.Conclusions: Wide variations in sensitivity status observed in the study are suggestive that antibiotic usage should be tailored to individual needs and proper selection of antibiotics for management of SSIs must be guided by laboratory antibiogram.

Role of Mechanical Bowel Preparation for Elective Colorectal Surgery / 대한소화기학회지

The presence of bowel contents during colorectal surgery has been related to surgical site infections (SSI), anastomotic leakage (AL) and postoperative complications theologically. Mechanical bowel preparation (MBP) for elective colorectal surgery aims to reduce fecal materials and bacterial count with the objective to decrease SSI rate, including AL. Based on many observational data, meta-analysis and multicenter randomized control trials (RTC), non-MBP did not increase AL rates or SSI and other complications in colon and even rectal surgery. In 2011 Cochrane review, there is no significant benefit MBP compared with non-MBP in colon surgery and also no better benefit MBP compared with rectal enemas in rectal surgery. However, in surgeon's perspectives, MBP is still in widespread surgical practice, despite the discomfort caused in patients, and general targeting of the colon microflora with antibiotics continues to gain popularity despite the lack of understanding of the role of the microbiome in anastomotic healing. Recently, there are many evidence suggesting that MBP+oral antibiotics (OA) should be the growing gold standard for colorectal surgery. However, there are rare RCT studies and still no solid evidences in OA preparation, so further studies need results in both MBP and OA and only OA for colorectal surgery. Also, MBP studies in patients with having minimally invasive surgery (MIS; laparoscopic or robotics) colorectal surgery are still warranted. Further RCT on patients having elective left side colon and rectal surgery with primary anastomosis in whom sphincter saving surgery without MBP in these MIS and microbiome era.

Protocol for developing a surveillance system for surgical site infections

Purpose: Healthcare-associated infections (HCAIs/ HAIs) are the most common adverse occurrences during health care delivery. Across the globe, millions of patients are affected by HAIs annually, with a higher burden and impact in developing nations. a major lacuna in planning preventing protocols is the absence of National Surveillance Systems in most low-middle income countries, which also prevents allocation of resources to the high-priority areas. Among all the HAIs, there is a huge global burden of SSIs, in terms of morbidity, prolonged hospital stays, increased antimicrobial treatment as well as attributable mortality. Method: This manuscript details the process of establishment of an SSI surveillance protocol at a level-1 trauma centre in North India. Result and Conclusion: Surveillance is an essential tool to reduce this burden. It is also an important primary step in recognizing problems and priorities, and it plays a crucial role in identifying risk factors for SSI and to be able to target modifiable risk factors. Therefore, it is imperative to establish reliable systems for surveillance of HAIs, to regularly estimate the actual burden of HAIs, and to use these data for developing indigenous preventive measures, tailored to the country's priorities.

Antimicrobial Susceptibility of Organisms Isolated from Surgical Site Infection in a Tertiary Care Hospital, Bettiah (West Champaran) Bihar, India

Introduction: Surgical site infections are most commonhospitals acquired infections and are an important cause ofmorbidity and mortality. The objective of our study is toconclude the causative bacteria and antimicrobial sensitivityof surgical site infections.Material and methods: A total of 275 various clinicalsamples received in Microbiology Laboratory, GovernmentMedical College, Bettiah (West Champaran) Bihar andAssociated Hospital. from March 2018 to April 2019. Atotal 101 Staphylococcus aureus isolated, were identifiedby standard biochemical methods. Antibiotic susceptibilitytesting was performed by Kirby Bauer Disc Diffusion method.Methicillin resistance was detected by using cefoxitin (30µg)disc diffusion method as per CLSI guidelines 2016.Result: Out of the 275 aerobic bacteria which were isolated,144 were gram positive cocci (52.37%) and 131 were gramnegative bacilli (47.63%). The most common pathogenfollowed by Staphylococcus aureus 101 (36.36%). Otherorganisms were Escherichia, Pseudomonas, Klebsiella,Citrobacter, Proteus, and Enterococcus. The Antimicrobialprofile of 101 Staphylococcus aureus isolates among MRSA,resistance those they were 100% sensitive to linezolidand vancomycin, with moderate sensitivity (71.14%) tocefuroxime, gentamicin and least sensitivity to (23.81%)doxycycline, (20.95%) ciprofloxacin.Conclusion: Isolation of MRSA patients and carriers in thehospitals, regular surveillance, and monitoring of antibioticsusceptibility pattern of the hospital and community of thatregion regularly and formulation of antibiotic policy may helpin reducing the treatment failures.

Clinical Study of Causative Factors Precautionary Measures and Treatment of Surgical Site Infections

Introduction: Surgical site infections (SSIs) still remain a significant problem following an operation and third most frequentlyreported nosocomial infections. SSI contributes significantly to increase health-care costs in terms of prolonged hospital stayand lost working days.Aim: This study aims to study the prevalence, risk factors, prevention, and treatment of surgical site infection.Materials and Methods: In this study, 1570 elective and emergency general surgical cases involving clean and cleancontaminated surgeries were included in the study. An elaborate study of these cases with regard to the date of admission,history, clinical features date of surgery, type of surgery, emergency or elective, pre-operative preparation, and post-operativemanagement is done till the patient is discharged from the hospital and then followed up the patient on OPD basis for anysigns of wound infection.Results: In the present study, the overall post-operative SSI rate in elective clean and clean-contaminated cases is 5.11% andemergency cases is 12.41%. From the above observation, it shows that the superficial SSIs are the most common type andaccounted for about 72.09% in elective and 61.11% in an emergency of all the SSIs and deep surgical site infection accountedfor about 23% in elective and 30.55% in emergency cases. Escherichia coli and Proteus mirabilis were the most commonorganisms isolated in my study in elective and emergency cases, respectively.Conclusion: The study emphasizes the need for the evidence-based infection control and to identify the patients susceptibleto wound infection which helps in reducing the hospital stay and reduces hospital cost.

Relationship Of Perioperative Hyperglycemia And Postoperative Infection In Elective Abdominal Surgery In Non Diabetic Patient

BACKGROUND: Postoperative infections are common in surgical patients leading to increased morbidity and mortality. Patients are susceptible to stress-induced hyperglycemia following operation, independent of the diabetic status. Perioperative hyperglycemia in critically ill surgical patients increases the risk of postoperative infections and its consequences. Despite 30 million operations performed in United States and much more in India each year, the clear association between perioperative blood glucose (BG) level and postoperative infection (POI) remain ill-defined for the majority of surgery patients. AIM: To identify the relationship of perioperative hyperglycemia and post-operative infection in elective abdominal surgery in non diabetic patients. MATERIAL AND METHODS: This is a prospective, observational study of 150 patients who were non diabetic and underwent an elective abdominal surgery. The primary outcome of interest was POI, defined as the occurrence of 1 or more reports of pneumonia, wound infections, urinary tract infections, and sepsis in the first 30 days after surgery and one year after surgery in case of use of prosthesis. The primary predictor of interest was peri-operative hyperglycemia, defined as the RBS of >150mg/dl in the perioperative period (just prior to surgery and within 12 hr and within 24 hr after the skin closure). In the study 500 patient were screened for perioperative hyperglycemia out of which only 150(30%) patient had RBS>150mg/dl in perioperative period. RESULTS AND CONCLUSIONS:There was significant change in RBS in the perioperative period. The overall incidence of POI in 150 cases of Elective Abdominal Surgeries was 7.33%. Wound infection was observed in 7 cases (4.66%) and 4 cases (2.66%) had respiratory complication. Risk factors like old age, contaminated wound, higher ASA grade and increased duration of surgery are associated with increased POI.The most common complication was wound infection

Phenotypic characterization and susceptibility of gram negative bacteria from surgical site infections in a tertiary care hospital

Background: Gram negative bacteria are the common isolates among the cases of Surgical Site Infections (SSI). Resistant and specially Multi Drug Resistant (MDR) Gram negative isolates are a serious challenge for the treatment to clinicians. Present study was undertaken for phenotypic characterization and susceptibility pattern of Gram negative bacterial isolates from cases of surgical site infections in a tertiary care institute.Methods: This descriptive cross sectional hospital based study was conducted in a tertiary care teaching hospital over a period of one and half year from January 2012 to June 2013. Centers for disease control and prevention (CDC) SSI case definitions were used to label a case as SSI. Only culture proven cases, out of clinically suspected was included in the study for evaluation.Results: During the study period a total of 5949 patients were operated and screened for SSI in the wards under surveillance. Out of which 556 were clinically suspected as a case of SSI. With 408 culture proven cases of SSI the rate of SSI in present study was (6.86%). Rates of SSI were more in dirty (22.54%) and contaminated (13.78%) type of wounds. Among Gram negative bacterial isolates (n=343) from SSI, E. coli (45.18%) was the commonest followed by Pseudomonas aeruginosa (16.03%) and Klebsiella pneumoniae (13.42%). Unpleasant trend in antimicrobial resistance observed during study is a serious concern.Conclusions: The data presented in this study clearly indicate the continuous need of surveillance of SSI. This will clearly help health care personnel in curtailing down the incidences of SSI.

A clinical study of post-operative complications of emergency and elective (open and laparoscopic) appendicectomy

Background: Post-operative complications which follows appendicectomy are not common and it reflect the level of peritonitis that is present during the time of surgery and the diseases which may be predisposed to complications. There are various types of complications that occurred after the appendicectomy surgery. Of them, the commonest complications are fever and surgical site infection. Post-operative complications of appendicectomy have wide range of presentation from fever to fecal fistula. In this study, the patients presenting with features of post-operative complications of appendicectomy will undergo detailed history taking, clinical examination & investigations like complete blood count, blood sugar, urea and lipid profile, serum creatinine, X-ray chest and wound pus culture sensitivity. The study purpose was to assess the age distribution, sex distribution & to discuss various types of complication. Materials and methods: 100 cases that had presented with features of post-operative complications of appendicectomy in the department of surgery, Tirunelveli Medical College and Hospital were evaluated during the study period from April 2012 to October 2013. Results: Our study of 100 randomly selected patients who presented with postoperative complications of appendicectomy. The commonest post-operative complications of appendicectomy were fever (73%), followed by surgical site infection (37%). Most common age group, in which post-operative complications seen, was > 20 years, followed by the 20-30 age group. The surgical site infections were most commonly due to E.coli (64.86%) and Klebsiella species (8.1%). The common day of presentation of fever was 2nd POD with 57.3% cases. In this study 97% case of postoperative complications of appendicectomy occurred after emergency surgeries. R. Maheshwari, Rakesh Fernando. A clinical study of post-operative complications of emergency and elective (open and laparoscopic) appendicectomy. IAIM, 2018; 5(7): 62-66. Page 63 Conclusion: Major complications were rare in elective appendicectomies which may reflect the reduced virulence of organisms in those cases.

Surgical Site Infections in a Rural Hospital: A Prospective Study.

Background: Surgical site infection (SSI) is one of the common causes of hospital-acquired infections, leading to high morbidity and mortality. SSIs contribute mainly about the increased health care costs in terms of prolonged hospital stay and lost work days. The infections are different in different areas and largely neglected in our area. It is very important to document and notify the incidence of SSI, which will help in proper categorization and surveillance of the patients, helps to identify the type of patients susceptible for wound infections. Aims and Objectives: To estimate the incidence, study bacteriology, and the factors associated with the occurrence of SSI in the study setting. Materials and Methods: The present prospective study was conducted in the surgical wards of MNR Medical College and Hospital, Sangareddy, Medak District, Telangana, India. Clinico-bacteriological follow-up of 100 post-operative cases to the development of SSI, as per the Center for Disease Prevention and Control criteria (1991). Incidence was expressed as the infection rate per 100 operations. Bacteriology was documented by sending pus for analysis. Association was tested by applying the Student’s t-test and the Chi-square test of significance. P < 0.05 was considered as significant. Results: The SSI rate was estimated to be 8% for clean, 58.3% for clean-contaminated, 85% for contaminated operations, and 66.6% for dirty cases. 38.46% of the isolates were Escherichia coli. Conclusion: The study emphasizes the need for the evidence-based infection control and to identify the patients susceptible for wound infection which helps in reducing the hospital stay and reduces hospital cost.

Risk factors of surgical site infections for patients with cholelithiasis after biliary tract surgery / 中华肝胆外科杂志

Objective To identify the independent risk factors of surgical site infections (SSIs) for patients with cholelithiasis after biliary tract surgery.Methods 712 patients were enrolled from April 2010 to April 2015 in this study and their clinical data were retrospectively analyzed.There were 106 patients who developed SSIs.The risk factors of SSIs and their three subtypes (superficial incisional SSIs,deep incisional SSIs,and organ/space SSIs) were analyzed.The total hospitalization cost,length of hospitalization and patients who stayed over 30 days in hospital were compared between the group of patients with and without SSIs.Results Univariate analysis showed that SSIs were associated with diabetes,emergency operation,bile duct re-exploration,hepatectomy,positive bile bacteria culture,porta hepatis clamping,Ⅱ-Ⅳ grades of cholelithiasis,ASA Grade 3,BMI ＞ 30,hepatic function Grade B and protein level ＜ 30 g/L on hospital admission (all P ＜ 0.05).The results also indicated that superficial incisional SSIs,deep incisional SSIs and organ/space SSIs were correlated with emergency operation,bile duct re-exploration,hepatectomy,operation time,porta hepatis clamping,smoking,ASA score and protein level on hospital admission (all P ＜ 0.05).The total hospitalization expense,length of hospital stay and the number of patients hospitalized for over 30 days in the SSIs Group were significantly more than the non-SSIs Group (all P ＜ 0.05).Bile duct re-exploration,hepatectomy,positive bile bacteria culture and Ⅱ-Ⅳ grades of cholelithiasis were independent risk factors of SSIs on multivariate unconditional logistical regression analysis (all P ＜ 0.05).Conclusions Multiple factors in the perioperative period were involved in SSIs after bile duct surgery.Bile duct te-exploration,hepatectomy,positive bile bacteria culture and Ⅱ-Ⅳ grades of cholelithiasis were independent risk factors of SSIs.

Predictive factors of post-discharge surgical site infections among patients from a teaching hospital

Introduction Surgical site infections (SSIs) often manifest after patients are discharged and are missed by hospital-based surveillance. Methods We conducted a case-reference study nested in a prospective cohort of patients from six surgical specialties in a teaching hospital. The factors related to SSI were compared for cases identified during the hospital stay and after discharge. Results Among 3,427 patients, 222 (6.4%) acquired an SSI. In 138 of these patients, the onset of the SSI occurred after discharge. Neurological surgery and the use of steroids were independently associated with a greater likelihood of SSI diagnosis during the hospital stay. Conclusions Our results support the idea of a specialty-based strategy for post-discharge SSI surveillance. .