RESUMEN
Background: Surgery for perforation peritonitis is associated with the highest rates of infective complications, especially surgical site infection. SSI occurs due to failure of obliteration of dead space during abdominal wound closure resulting in formation of hematoma and seroma collection in the surgical wound viz. abdominal wound in cases of perforation peritonitis. This acts as a good culture medium for bacterial organisms to grow and cause wound infection. The bacterial pathogens can be either from intra-abdominal sepsis or nosocomial in origin. Closed suction drains can be used effectively to eliminate dead space in the wound and evacuates the seroma or hematoma collection, thereby reducing chances of SSI and also helps in early detection of SSI by inspecting the nature of drain output. Aim was to evaluate the role of closed suction drains in prevention of SSI in cases of perforation peritonitis. Methods: Comparative study of 60 cases of perforation peritonitis divided into two equal groups (Group A patient with closed suction drain in subcutaneous space vs. Group B patient without closed suction drain). Outcomes of SSI were compared. Results: The incidence of SSI in Group A was 33% whereas in Group B was 70%. 40% cases in SSI in Group A whereas 76% cases of SSI in Group B developed wound dehiscence. Most cases of SSI was diagnosed on POD 2 for Group A and on POD 4 for Group B. Conclusions: The study supports use of closed suction drain in perforation peritonitis for prevention, early detection and appropriate management of SSI.
RESUMEN
Background: Surgery for perforation peritonitis is associated with the highest rates of infective complications, especially surgical site infection. SSI occurs due to failure of obliteration of dead space during abdominal wound closure resulting in formation of hematoma and seroma collection in the surgical wound viz. abdominal wound in cases of perforation peritonitis. This acts as a good culture medium for bacterial organisms to grow and cause wound infection. The bacterial pathogens can be either from intra-abdominal sepsis or nosocomial in origin. Closed suction drains can be used effectively to eliminate dead space in the wound and evacuates the seroma or hematoma collection, thereby reducing chances of SSI and also helps in early detection of SSI by inspecting the nature of drain output. Aim was to evaluate the role of closed suction drains in prevention of SSI in cases of perforation peritonitis. Methods: Comparative study of 60 cases of perforation peritonitis divided into two equal groups (Group A patient with closed suction drain in subcutaneous space vs. Group B patient without closed suction drain). Outcomes of SSI were compared. Results: The incidence of SSI in Group A was 33% whereas in Group B was 70%. 40% cases in SSI in Group A whereas 76% cases of SSI in Group B developed wound dehiscence. Most cases of SSI was diagnosed on POD 2 for Group A and on POD 4 for Group B. Conclusions: The study supports use of closed suction drain in perforation peritonitis for prevention, early detection and appropriate management of SSI.
RESUMEN
Background: Placing a suction drain following total knee replacement is usual practice which is been followed by many surgeons. Closed suction drainage following arthroplasty is a routine with the aim of preventing wound hematoma and thereby reducing the risk of infection. Surgical site infections (SSI) in orthopaedic surgeries are disastrous and often lead to significant morbidity and mortality. Usefulness of drain tip culture in predicting the wound infection is been tested but results are controversial. Methods: It is a prospective study of 546 drains (352 patients) who underwent unilateral or bilateral Total Knee Arthroplasty (TKA). The drain tip was sent for culture at the time of removal. Cultures from the SSI were also collected. Cases that had at least six months of follow up were included in the study. Results: Drain tip culture was positive in total of 18 patients. Three patients had developed deep infection and 10 patients had superficial infection. All three patients with deep infection and 9 out of 10 patients of superficial infection were drain tip culture positive. Out of 9 culture positive superficial infections, one had different bacteria identified from the wound site. Drain tip culture was positive in 3.39% of drains and infection (wound culture) was positive in 2.26% of wounds. On statistical analysis we found drain tip culture has sensitivity of 91.66%, specificity of 98.64%, positive predictive value of 61.11% and negative predictive value of 99.8%. Conclusion: Drain tip culture positivity helps in predicting the future chance of developing the infection. If drain tip culture is negative, then there is almost near nil chances of infection.