FACTORS AFFECTING SURGICAL SITE INFECTION IN OPEN GASTROINTESTINAL SURGERY

Surgical site infection is more prevalent in open gastrointestinal surgery which will affect hospital stay and morbidity and mortality of patients.In our study,we are comparing the factors which will directly or indirectly causes SSI.By knowing the factors which causing SSI,We can decreases the incidence of surgical site infection.

Bacteriological Profile and Antimicrobial Susceptibility Patterns of Bacteria Isolated from Surgical Site Infections of Patients Attending a Tertiary Care Hospital

Introduction: Surgical site infections (SSIs) are one of themajor causes of morbidity and mortality in developing countriesdespite recent advances in aseptic techniques. The SSIs dueto emerging multidrug resistance (MDR) bacteria isolates areconsidered as grave threats to the public health worldwide.Each hospital has specific type of microbial flora from whichinfection initiates. In such condition microorganism showsunique type of antibiotic susceptibility and resistance pattern.In this study we report on the microbiological spectrum ofSSIs and the antimicrobial susceptibility pattern with a viewto provide guide to the clinicians for making rational decisionover the choice of antibiotics in the management of surgicalsite infection.Material and Methods: This cross-sectional study wascarried out in a tertiary care hospital and the 560 sampleswere collected, processed in the microbiology laboratory andevaluated for the study.Results: Out of 376 growth positive samples, Gram NegativeBacilli (GNB) were isolated from 271 (72%) samples andGram Positive Cocci (GPC) were isolated from 105 (28%)samples. Among the isolated GNB, only 5 to 10% weresensitive to third generation Cephalosporins. Sensitivity toFluroquinolones (Ciprofloxacin and Levofloxacin) was alsolow (Only 5% to 10% were sensitive). Only 3 to 15% of theGNB were found sensitive to Co-amoxiclav and 6.5% to 23%were sensitive to Ampicillin-Sulbactam. About 60% of thePseudomonas aeruginosa and about 40% of the Klebsiellaspp and Acinetobacter baumanii were found resistant toMeropenem.Conclusion: Gram Negative Bacilli predominated overGram Positive Cocci in surgical site infections in our setup. Very low sensitivity to 3rd generation Cephalosporins,Ampicillin, Co-amoxiclav and Fluroquinolones was notedamong GNB isolates and an increasing pattern of resistanceto Aminoglycosides and Carbapenems was also noted amongMDR Pseudomonas aeruginosa and Acinetobacter baumaniiisolates. More than 50% of the MDR Acinetobacter spp.were was found sensitive to Ampicillin- Sulbactam andMinocycline.

Inappropriate surgical chemoprophylaxis and surgical site infection rate at a tertiary care teaching hospital

OBJECTIVES: This study aimed to analyze the pattern of surgical chemoprophylaxis, surgical site infection rate, and to check rationality of surgical chemoprophylaxis based on Kunin's criteria. MATERIALS AND METHODS: A prospective, observational study was performed on patients undergoing surgery, in a tertiary care teaching hospital. Data were collected in a pro-forma which included the patients' details, prescriptions from date of admission to discharge or any other outcome and operative notes. Surgical site infection as defined by Centre for Disease Control criteria was recorded. Rationality was assessed based on Kunin's criteria. RESULTS: Total 220 patients were enrolled over a period of one year. Mean hospital stay was 8.67 ± 5.17 days. A total of 2294 drugs were prescribed out of which 840 (36.61%) were antimicrobials. Mean duration for pre-operative intravenous antimicrobial therapy was 0.75 ± 0.45 day and for post-operative intravenous antimicrobial therapy was 3.33 ± 2.24 days while post-operative oral antimicrobial therapy was 4.58 ± 3.34 days. Third generation cephalosporins were prescribed most frequently 64.74% and 64.40% pre-operatively and post-operatively respectively. Antimicrobial prescribing was inappropriate in 52.28%. Total of 19 patients developed surgical site infection. Surgical site infection rate was significantly higher (13.04%) in patients receiving inappropriate chemoprophylaxis (p < 0.01). Surgical site infection adds 9.98 days of hospital stay (p < 0.0001) and 3.57 extra drugs (p < 0.0001) compared to group without surgical site infection. CONCLUSION: Inappropriate use of antimicrobials is highly prevalent in surgical chemoprophylaxis leading to higher surgical site infection rate. Adoption of international standard and formulation of locally feasible guidelines can help overcome this situation.

Management of Infection for Methicillin Resistant Staphylococcus aureusat an Orthopaedic Surgery Department / 대한정형외과학회잡지

PURPOSE: This study was undertaken to find two things. One was to reveal the infection route of methicillin resistant Staphylococcus aureus(MRSA) that causes serious nosocomial infection through epidemic study, and the other was to seek preventative methods through blocking the dispersion. MATERIALS AND METHODS: We cultured MRSA obtained by nasal cavity swabbing, from 82 doctors and 219 personnel in our hospital, between September 1997 and August 1999. In addition, swabs were taken from the nasal cavities and surgical sites of 57 orthopaedic surgery patients, who were free of wound infection. In this practice, we use the disc test for drug sensitivity, and pulse-field gel electrophoresis (PFGE) to separate colonies. RESULTS: MRSA was discovered in 8 doctors (10%) and in 13 personnels (6%) by nasal cavity sabbing, and these included 3 orthopaedic surgeons. MRSA was also found in the patients' group, there were 23 (40%) from nasal cavities and 14 ones (25%) from surgical sites. Their PFGE types of MRSA were of A type, which were also identified in two orthopaedic surgeons. SUMMARY: We noticed that nasal cavitiy infection could occur by cross infection between doctors and patients. Surgical wound infection may occur by infection from the nasal cavity. This study underlines the importance of MRSA infection and management.