Bacterial profile and antimicrobial susceptibility patterns of isolates among patients diagnosed with surgical site infection at a tertiary teaching hospital in Ethiopia: a prospective cohort study.

BACKGROUND: Globally, surgical site infections are the most reported healthcare-associated infection and common surgical complication. In developing countries such as Ethiopia, there is a paucity of published reports on the microbiologic profile and resistance patterns of an isolates. OBJECTIVE: This study aimed at assessing the bacterial profile and antimicrobial susceptibility patterns of isolates among patients diagnosed with surgical site infection at Jimma Medical Center in Ethiopia. METHODS: A prospective cohort study was employed among adult patients who underwent either elective or emergency surgical procedures. All the eligible patients were followed for 30 days for the occurrence of surgical site infection (SSI). From those who developed SSI, infected wound specimens were collected and studied bacteriologically. RESULTS: Of 251 study participants, 126 (50.2%) of them were females. The mean ± SD age of the patients was 38 ± 16.30 years. The overall postoperative surgical site infection rate was 21.1% and of these 71.7% (38/53) were culture positive. On gram stain analysis, 78% of them were Gram-negative, 11.5% were Gram-positive and 10.5% were a mixture of two microbial growths. Escherichia coli accounted for (21.43%), followed by Pseudomonas aeruginosa (19.05%), Proteus species (spp.) 14.29%), Staphylococcus aureus (11.90%), Klebsiella species (11.90%), Citrobacter spp. (9.5%), streptococcal spp. (7.14%), Coagulase-negative S. aureus (CoNS) (2.38%) CONCLUSION: Gram-negative bacteria were the most dominant isolates from surgical sites in the study area. Among the Gram-negative bacilli, Escherichia coli were the most common bacteria causing surgical site infection. As there is high antibiotic resistance observed in the current study, it is necessary for routine microbial analysis of samples and their antibiogram.

Incidence, risk factors and outcomes of surgical site infections among patients admitted to Jimma Medical Center, South West Ethiopia: Prospective cohort study.

BACKGROUND: Surgical site infections are one of the leading health care-associated infections in developing countries. Despite improvements in surgical technique and the use of best infection prevention strategies, surgical site infections remained the major cause of hospital acquired infections. Therefore, this study aimed to determine incidence, risk factors, and outcomes of surgical site infections among patients admitted to Jimma Medical Center, South West Ethiopia. METHODS: A hospital based prospective cohort study design was employed to follow adult patients admitted to general surgery ward, orthopaedic ward and gynaecologic/obstetrics ward of Jimma Medical Centre, from April 20 to August 20, 2019. All patients were followed daily before, during and after operation for 30 days to determine the incidence of surgical site infection and other outcomes. Data was entered using EpiData version 4.2 and analyzed using statistical software package for social science version 20.0. To identify the independent predictors of outcome, multiple stepwise backward cox regression analysis was done. Statistical significance was considered at p-value <0.05. RESULTS: Of total of 251 participants included to the study, about 126 (50.2%) of them were females. The mean ± SD age of patients was 38 ± 16.30 years. Considerable number of patients 53(21.1%) developed surgical site infections. American Society of Anaesthesiologists score ≥3 [ Adjusted Hazard Ratio (AHR) = 2.26; 95%CI = (1.03-4.93)], postoperative antibiotic prescription [AHR = 3.2; 95%CI = (1.71-6.01)], contaminated-wound [AHR = 7.9; 95%CI = (4.3-14.60)], emergency surgery [AHR = 2.8; 95% CI = (1.16-6.80)], duration of operation ≥ 2 h [AHR = 4; 95% CI = (2.17-7.50)] and comorbidity [AHR = 2.52; 95%CI = (1.28-4.94)] were independent predictors for surgical site infections. Twenty nine (11.6%) patients returned to operation room. The result of the multivariate cox regression analysis showed that SSI [AHR (95% CI) = 7(3.16-15.72)], and incision site [AHR (95% CI) = 2.5(1.14-5.42)] had statistically significant association with re-operation. CONCLUSION: The incidence of surgical site infection was high in the study setting. There were significant numbers of contributing factors for the occurrence of surgical site infections. Although no mortality observed during the study period, significant number of patients re-operated. Large multicenter study is urgently needed to confirm the outcome of this study.