Bacteriological study of surgical site infections in a tertiary care hospital at Miraj, Maharashtra state, India
Keywords:Surgical site infections, Post-operative wound infections, Clean and clean-contaminated wound, MRSA
Background: Surgical site infections (SSI) are one of the common post-operative complications. Apart from bacterial contamination of wound, various patient and environment related factors play role in development and outcome of SSI. The present study is undertaken to study the frequency of SSI with reference to factors contributing to it and the antimicrobial susceptibility pattern of the causative organisms.
Methods: This single-observer, cross-sectional, complete-enumeration prospective study was carried out over a period of one year. 196 pus samples from cases of surgical site infections were processed for gram staining, culture, biochemical identification tests and antimicrobial susceptibility testing. Methicillin-Resistant Staphylococcus aureus (MRSA) strains were detected by using oxacillin and cefoxitin disk diffusion and minimum inhibitory concentration (MIC) of oxacillin was tested by broth dilution technique.
Results: The overall frequency of SSI was 6.17%. Most common isolates were Staphylococcus aureus, coagulase negative Staphylococci (CONS), E. coli and Pseudomonas aeruginosa. The frequency of MRSA was 8.6%. The maximum frequency was among patients operated on emergency basis in surgical department.
Conclusions: The most important determinants for SSI were emergency surgery and presence of co-morbid conditions. The frequency of occurrence was age-dependent, with maximum rate of SSI in males and females in the third and sixth decades of life, respectively.
Kirby JP, Mazuski JE. Prevention of surgical site infection. Interventional studies for preventing surgical site infections in sub-Saharan Africa: A systematic review. Int J Surg. 2012;10(5):242-9.
National Nosocomial Infections Surveillance System. National Nosocomial Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issues October 2004. Am J Infect Control. 2004;32:470-85.
Langelotz C, Mueller-Rau C, Terziyski S, Rau B, Krannich A, Gastmeier P, et al. Gender-specific differences in Surgical Site Infections: An analysis of 438, 050 surgical procedures from the German National Nosocomial Infections Surveillance System. Viszeralmedizin. 2014;30(2):114-7.
Mundhada AS, Tenpe S. A study of organisms causing surgical site infections and their antimicrobial susceptibility in a tertiary care Government Hospital. Indian J Pathol Microbiol. 2015;58(2):195-200.
Owens CD, Stoessel K. Surgical Site Infections: epidemiology, microbiology and prevention. J Hosp Infect. 2008;70 Suppl-2:3-10. Interventional studies for preventing surgical site infections in sub-Saharan Africa: A systematic review. Int J Surg. 2012;10(5):242-9.
Collee JG, Miles RS, Watt B. Tests for identification of bacteria. In: Collee JG, Fraser AG, Marmion BP, Simmons A. (Eds.) Mackie & McCartney’s Practical Medical Microbiology. 14th Edn. London: Churchill Livingstone. 2006:131-49.
Skov R, Smyth R, Clausen M, Larsen AR, Frimodt-Moller N, Olsson-Liljequist B, et al. 2003. Evaluation of a cefoxitin 30 μg disc on Iso-Sensitest agar for detection of methicillin-resistant Staphylococcus aureus. J. Antimicrob. Chemother. 2003;52(2):204-7.
Brown DFJ, Edwards DI, Hawkey PM, Morrison D, Ridgway GL, Towner KJ, et al. Guidelines for the laboratory diagnosis and susceptibility testing of methicillin-resistant Staphylococcus aureus. Jour Antimicrob Chemother. 2005;56:1000-18.
Evans HL, Sawyer RG. Preventing bacterial resistance in surgical patients. Surg Clin North Am. 2009;89(2):501-19.
Barnes BA, Behringer GE, Wheelock FC, Wilkins EW. Postoperative sepsis: trends and factors influencing sepsis over a 20-year period reviewed in 20,000 cases. Ann Surg 1961;154(4):585-98.
Kurhade A, Akulwar S, Mishra M, Kurhade G, Justiz-Vaillant A, Kurhade K, et al. Bacteriological study of post-operative wound infections in a tertiary care hospital. J Bacteriol Parasitol. 2015;6(6):251
Barchitta M, Matranga D, Quattrocchi A, Bellocchi P, Ruffino M, Basile G, et al. Frequency of surgical site infections before and after the implementation of a multimodal infection control programme. J Antimicrob Chemother. 2012;67(3):749-55.
Rajkumari N, Sharma K, Mathur P, Kumar S, Gupta A. A study on surgical site infections after trauma surgeries in a tertiary care hospital in north India. Indian J Med Res. 2014;140(5):691-4.
Golia S, Kamath ASB, Nirmala AR. A study of superficial surgical site infections in a tertiary care hospital at Bangalore. Int J Res Med Sci. 2014;2(2):647-52.
Anvikar AR, Deshmukh AB, Karyakarte RP, Damle AS, Patwardhan NS, Malik AK, et al. A one year prospective study of 3280 surgical wounds. Indian J Med Microbiol 1999;17(3):129-32.
Lilani SP, Jangale N, Chowdhary A, Daver GB. Surgical site infection in clean and clean-contaminated cases. Indian J Med Microbiol. 2005;23(4):249-52.
Sharan H, Misra AP, Mishra R. Determinants of Surgical Site infection in rural Kanpur, India. J Evol Med Dent Sci. 2012;1(6):921-928.
deSa LA, Sathe MJ, Bapat RD. Factors influencing wound infection (a prospective study of 280 cases). J Postgrad Med. 1984;30(4):232-6.
Murthy R, Sengupta S, Maya N, Shivananda PG. Incidence of post-operative wound infection and their antibiogram in a teaching and a referral hospital. Indian J Med Sci. 1998;52(12):553-5.
Suchitra Joyce B, Lakshmidevi N. Surgical site infections: Assessing risk factors, outcomes and antimicrobial sensitivity patterns. Afr J Microbiol Research. 2009;3(4):175-9.
Awad SS, Elhabash SI, Lee L, Farrow B, Berger DH. Increasing incidence of Methicillin resistant Staphylococcus aureus skin and soft tissue infections: reconsideration of empiric antimicrobial therapy. Am J Surg 2007; 194(5): 606-10.
Majumder D, Bordoloi JS, Phukan AC, Mahanta J. Antimicrobial susceptibility pattern among methicillin resistant staphylococcus isolates in Assam. Indian J Med Microbiol. 2001;19(3):138-40.
Shobha KL, Rao PS, Thomas J. Survey of Staphylococcus isolates among hospital personnel, environment and their antibiogram with special emphasis on MRSA. Indian J Med Microbiol 2005; 23(3):186-8.
Vijayalaxmi N, Mohapatra LN, Bhujwala RA. Biological characters and antimicrobial sensitivity of S. epidermidis isolated from human source. Indian J Med Res 1980;72:16-22.
Marinello MA, Pierion C, Chenoweth C. The stethoscope, potential source of nosocomial infections? Arch Inter Med 1997;157:786-90.
Udaya Shankar C, Harish BN, Umesh Kumar PM, Navaneeth BV. Prevalence of MRSA in JIPMER hospital – a preliminary report. Indian J Med Microbiol 1997;15 (3):137-8.