Microbial Etiology and Antibiogram of SSIs following LSCS in a Tertiary Care Hospital in Amritsar

ABSTRACT

Surgical Site Infections (SSIs) are the second most commonly reported nosocomial infections after Urinary tract infection following a delivery by caesarean section. They add significantly to the morbidity, mortality and socioeconomic consequences in both patients as well as health care systems. Aim: To study the microbial etiology and antibiogram of post caesarean SSIs. Methods: This prospective study was conducted on pregnant women undergoing elective/emergency caesarean section irrespective of the indication during a study period from Jan 2017 to June 2018. 250 pregnant women undergoing LSCS developing signs and symptoms suggestive of SSI till the 30th post-operative day were included as cases. Under all aseptic precautions, two pus swabs were collected from every post caesarean women enrolled in the study. The first swab was used for gram staining while the other was inoculated on 5% blood agar and Macconkey agar. The isolates were identified by their colony characters and their standard biochemical tests. Antimicrobial susceptibility pattern was performed on Mueller Hinton agar plates by Kirby Bauer disc diffusion methods and interpreted as per latest CLSI guidelines. Results: Among 250 cases suspected of having SSIs, 93 aerobic isolates were obtained. Staphylococcus aureus (41.9%) was the most common organism isolated followed by Acinetobacter baumanii (15.1%), Escherichia coli(11.8%) Klebsiella pneumoniae(9.7%). 15/39(38.4%) of Staphylococcus aureus were observed to be Methicillin resistant. 15/45 (33.3%) of Gram negative isolates were Extended Spectrum Beta- Lactamase producers. Conclusion: Since MRSA is the leading cause of post caesarean SSI and the incidence of multidrug resistant pathogens as a cause of post-operative wound infections is rising with the increased prevalence of ESBL, therefore rational and judicious use of antimicrobials, active surveillance and reporting of SSI, enforcement of aseptic measures, implementation of infection control strategies and their periodic review is the need of an hour to reduce the rate of post caesarean SSIs.