RESUMEN
Background: Surgical site infections [SSI] are the most common nosocomial infections in surgical patients and lead to prolonged hospital stay, readmission to the hospital, and increased morbidity and mortality
Objectives: This study aimed to detect the incidence of SSI and the risk factors, the causative organisms and their antimicrobial susceptibility pattern in general surgery department at Sohag university hospital
Methodology: A prospective SSI surveillance at Sohag University hospital from [January 2017 to June 2017] using the criteria of the Centers for Disease Control. Basic demographic, surgical data and data of possible risk factors were collected from all patients. Patients were followed up for 30 days after surgery. Swabs were collected from cases with signs and symptoms of SSI and cultured on basic microbiological culture media. Isolated colonies were identified microscopically and biochemically. Full identification of the causative organisms and their antibiotic sensitivity were done by Vitek 2 compact automated system
Results:The study included 482 patients and the incidence of SSI infections was [11.2%]. Escherichia coli was the most common organism causing SSI and was responsible for [40%] of SSIs followed by Pseudomonas aeruginosa [20%], Staphylococcus aureus [20%], Enterobacter cloacae [10 %] and Klebsiellapneumoniae [10 %]. Most of isolated E. coli and Klebsiella were ESBL producers [73.3%]. Pseudomonas aeruginosa shows emergence of resistance to tigecycline [25%]. All isolated staph. aureus were [MRSA] and [10%] of them were [VRSA].Univariate regression analysis show that older age, urgent operation type, bad patient general condition, contaminated wound type, hypertension, obesity, intake of antibiotic prophylaxis and increased length of hospital stay [days] were risk factors for SSI. The multivariable regression analysis revealed that urgent operations type, bad patient condition, obesity increasing length of hospital stay [days] and intake of antibiotic prophylaxis independent risk factors for the development of a SSI
Conclusion: The study provides a valuable data about SSI in General Surgery Department and highlights risk factors associated with SSI, the causative pathogens and their antibiotic sensitivity in our hospital that can help in updating the antimicrobial prophylaxis policy and reducing the incidence of SSI
RESUMEN
Aim: a prospective study to compare different techniques in closing common bile duct after choledocho-lithotomy as T-tube drainage, intra-operative stenting, and primary closure with sphincterotomy as regard indications, operative time, hospital stay, complications, returns to work, coast, and feasibility
Methods: From April 2005 to May 2006, 52 patients suffering from common bile duct [CBD] stone were selected, and operated upon for choledocho-lithotomy then randomized into group A included 19 cases were subjected to T-tube drainage, group B included 18 cases were subjected to intra-operative stenting, and group C included 15 cases were subjected to primary closure and sphincterotomy, patients were followed up for a period of 6-9 months post-operatively for evaluation
Results: The three methods are effective and safe however, the hospital stay was reduced, the patients were more comfortable and rapidly return to work with CBD stents and primary closure compared to T-tube drainage, consequently the coast was reduced, however operative time was not significantly different, and also the complications was comparable
Conclusion: Intra-operative stenting of CBD and primary closure with sphincterotomy are effective, safe optional techniques after choledocho-lithotomy with better patient compliance, shorter hospital stay, and costly effective, and should be considered whenever feasible