Surgical site infection and pattern of antibiotic use in a tertiary care hospital in Peshawar.

BACKGROUND: Surgical site infection (SSI) is most common complication following surgical procedures. The objective of the study was to collect information on SSI regarding the most frequent pathogen in cases operated in casualty of Lady Reading Hospital (LRH) Peshawar, and sensitivity of the isolated pathogens to different antibiotics used. METHODS: The study was carried out at surgical 'B' unit (SBU) LRH from Jan 1, 2009 till Dec 31, 2009. A total of 100 patients who developed SSI after being operated for peritonitis following traumatic gut perforations, perforated appendix and enteric perforation. The patients included presented to casualty, operated in casualty OT and were shifted to the SBU, LRH. Children and patients operated on the elective list were excluded. Data was collected on specially designed proforma. Demographic details, details of SSI, culture/sensitivity reports and antibiotic used for prophylaxis and after C/S report were recorded. RESULTS: Out of a total of 100, 72 had superficial, 20 had organ/space and 8 had deep SSI. Organisms were isolated in 77 cases (77%). E. coli being most common pathogen (46%), followed by Pseudomonas (23%), mixed growth of Staph. Aureus or MRSA (13%), MRSA (5%) AND Staph aureus (4%) in descending order. No growth was reported in 23% of cases. CONCLUSION: E. coli was the most common organism involved in SSI in SBU LRH. The incidence of infection with MRSA in our unit is high. Combination of antibiotics like pipreacillin/Tazobactam, Cefoperazone/Sulbactam, were most effective against the isolated organisms. except MRSA where Linezolid, vancomycin and Tiecoplanin were effective.

Mortality and morbidity of abdominal inferior vena-caval injuries.

OBJECTIVE: To evaluate the outcome of abdominal inferior vena-caval (IVC) injuries in patients presented to Accident and Emergency Department, Lady Reading Hospital, Peshawar. DESIGN: An observational study. PLACE AND DURATION OF STUDY: The study was conducted at Postgraduate Medical Institute (PGMI)/Lady Reading Hospital, Peshawar, from January 1995 to January 2003. PATIENTS AND METHODS: Case records of all patients operated within specified period for vascular trauma having injuries to the abdominal inferior vena cava. In all cases vascular trauma management was done mainly on clinical assessment in a low equipped set up. Data on age, gender, mechanism, nature and location of inferior vena-caval injuries, other vascular and non-vascular injuries were recorded. RESULTS: There were 22 patients, 77.27% male and 22.72% female. Age ranged from 10 to 40 years with mean age of 25.09 years. Majority of injuries were caused by penetrating injury (77.27%), blunt injury in 04.54% and 18.87% were iatrogenic. Majority (95.45%) were having single laceration of inferior vena cava and 04.54% were having more than one laceration. Associated vascular injuries involved aortic 9.09%, internal iliac in 4.54% and renal vein in 4.54%. Most common associated non-vascular injury involved small intestine (72.72%) and large gut (50%). CONCLUSION: Inferior vena-caval injuries carries high mortality rate. When associated with multiple organ injuries and retrohepatic inferior vena-caval injuries are almost fatal.