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CC BY-NC-ND 4.0 · Journal of Gastrointestinal Infections 2022; 12(02): 106-111
DOI: 10.1055/s-0042-1760423
Original Article

Drug-Resistant Strains in Surgical Site Infections after Abdominal Surgery: A Prospective Study

Veenu Gupta
1   Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
,
Prateet Kaur
2   Department of Microbiology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
,
Deepinder Chhina
1   Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
,
Jaspal Singh
3   Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
,
Rama Gupta
1   Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Funding None.
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Abstract

Background Surgical site infection (SSI) is a common complication of abdominal surgery associated with substantial discomfort, morbidity, and cost.

Objective The aim of this study was to determine the incidence, risk factors, and antimicrobial susceptibility pattern of the associated bacterial causes of SSI in patients after abdominal surgery.

Methods A prospective study over a 1-year (Jan 2019–Dec 2019) period was conducted at a tertiary care institution in North India. Postoperative patients of abdominal surgeries with SSI were included in the study. Any exudate from the surgical site was collected aseptically and was processed as per standard operating procedures.

Results Of 2,509 patients with abdominal surgeries included in the study, 75 (2.98%, majority, i.e., 50 males) developed SSI. Common risk factors found to be associated with the development of SSI include contaminated surgical sites, obesity, age, immunosuppression, and simultaneous infection at some other sites, with a predominance (89.3%) of gram-negative isolates. Escherichia coli was the most frequently isolated organism (45.3%), followed by Klebsiella spp. (20%), Acinetobacter spp.(10.6%), Pseudomonas spp., and Staphylococcus aureus (8% each). There was a very high (53%) prevalence of extended-spectrum β lactamase production among the E. coli and Klebsiella isolates. Additionally, 58.8% of the E. coli isolates were multidrug-resistant, whereas 73.3% of the Klebsiella isolates were exclusively drug resistant. All the S. aureus isolates were found to be methicillin-resistant.

Conclusion Although the SSI rates after abdominal surgery were low, multidrug-resistant gram-negative bacteria were predominant in SSI.

Keywords

abdominal surgeries - surgical site infection - risk factors - antimicrobila susceptibility - multidrug-resistant

Ethical Statement

Not applicable.


Author Contributions

All authors contributed equally to the article.


Data Availability Statement

There is no data associated with this work.




Publication History

Received: 09 September 2022

Accepted: 07 November 2022

Article published online:
22 September 2023

© 2023. Gastroinstestinal Infection Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992; 13 (10) 606-608
    CrossrefPubMedSearch in Google Scholar
  • 2 Barie PS, Wilson SE. Impact of evolving epidemiology on treatments for complicated skin and skin structure infections: the surgical perspective. J Am Coll Surg 2015; 220 (01) 105-116 .e6
    CrossrefPubMedSearch in Google Scholar
  • 3 Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36 (05) 309-332
    CrossrefPubMedSearch in Google Scholar
  • 4 Anderson DJ, Chen LF, Sexton DJ, Kaye KS. Complex surgical site infections and the devilish details of risk adjustment: important implications for public reporting. Infect Control Hosp Epidemiol 2008; 29 (10) 941-946
    CrossrefPubMedSearch in Google Scholar
  • 5 Segal CG, Waller DK, Tilley B, Piller L, Bilimoria K. An evaluation of differences in risk factors for individual types of surgical site infections after colon surgery. Surgery 2014; 156 (05) 1253-1260
    CrossrefPubMedSearch in Google Scholar
  • 6 Ho VP, Stein SL, Trencheva K. et al. Differing risk factors for incisional and organ/space surgical site infections following abdominal colorectal surgery. Dis Colon Rectum 2011; 54 (07) 818-825
    CrossrefPubMedSearch in Google Scholar
  • 7 Azoury S, Farrow N, Hu Q. et al. Postoperative abdominal wound infection-epidemiology, risk factors, identification, and management. Chron Wound Care Manage Res 2015; 22 (02) 137-148
    Search in Google Scholar
  • 8 Stevens DL, Bisno AL, Chambers HF. et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59 (02) 10-52
    CrossrefPubMedSearch in Google Scholar
  • 9 Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ. Participants in the VA National Surgical Quality Improvement Program. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg 2005; 242 (03) 326-341 , discussion 341–343
    CrossrefPubMedSearch in Google Scholar
  • 10 Altemeier WA, Culbertson WR, Hummel RP. Surgical considerations of endogenous infections–sources, types, and methods of control. Surg Clin North Am 1968; 48 (01) 227-240
    CrossrefPubMedSearch in Google Scholar
  • 11 Anderson DJ. Surgical site infections. Infect Dis Clin North Am 2011; 25 (01) 135-153
    CrossrefPubMedSearch in Google Scholar
  • 12 Aga E, Keinan-Boker L, Eithan A, Mais T, Rabinovich A, Nassar F. Surgical site infections after abdominal surgery: incidence and risk factors. A prospective cohort study. Infect Dis (Lond) 2015; 47 (11) 761-767
    CrossrefPubMedSearch in Google Scholar
  • 13 Giri S, Kandel BP, Pant S, Lakhey PJ, Singh YP, Vaidya P. Risk factors for surgical site infections in abdominal surgery: a study in Nepal. Surg Infect (Larchmt) 2013; 14 (03) 313-318
    CrossrefPubMedSearch in Google Scholar
  • 14 Brandt C, Sohr D, Behnke M, Daschner F, Rüden H, Gastmeier P. Reduction of surgical site infection rates associated with active surveillance. Infect Control Hosp Epidemiol 2006; 27 (12) 1347-1351
    CrossrefPubMedSearch in Google Scholar
  • 15 Haley RW, Culver DH, White JW. et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985; 121 (02) 182-205
    CrossrefPubMedSearch in Google Scholar
  • 16 Mekhla, Borle FR. Determinants of superficial surgical site infections in abdominal surgeries at a Rural Teaching Hospital in Central India: a prospective study. J Family Med Prim Care 2019; 8 (07) 2258-2263
    CrossrefPubMedSearch in Google Scholar
  • 17 Offner PJ, Moore EE, Biffl WL. Male gender is a risk factor for major infections after surgery. Arch Surg 1999; 134 (09) 935-938 , discussion 938–940
    CrossrefPubMedSearch in Google Scholar
  • 18 Cohen B, Choi YJ, Hyman S, Furuya EY, Neidell M, Larson E. Gender differences in risk of bloodstream and surgical site infections. J Gen Intern Med 2013; 28 (10) 1318-1325
    CrossrefPubMedSearch in Google Scholar
  • 19 Lenhardt R, Hopf HW, Marker E. et al. Perioperative collagen deposition in elderly and young men and women. Arch Surg 2000; 135 (01) 71-74
    CrossrefPubMedSearch in Google Scholar
  • 20 Malone DL, Genuit T, Tracy JK, Gannon C, Napolitano LM. Surgical site infections: reanalysis of risk factors. J Surg Res 2002; 103 (01) 89-95
    CrossrefPubMedSearch in Google Scholar
  • 21 Martin ET, Kaye KS, Knott C. et al. Diabetes and risk of surgical site infection: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2016; 37 (01) 88-99
    CrossrefPubMedSearch in Google Scholar
  • 22 Narula H, Chikara G, Gupta P. A prospective study on bacteriological profile and antibiogram of postoperative wound infections in a tertiary care hospital in Western Rajasthan. J Family Med Prim Care 2020; 9 (04) 1927-1934
    CrossrefPubMedSearch in Google Scholar
  • 23 Bansal D, Singh RR, Ded KS. et al. Bacteriological profile and antimicrobial susceptibility in surgical site infection in elective abdominal surgeries. Int Surg J 2016; 3: 1879-1882
    CrossrefSearch in Google Scholar
  • 24 Misha G, Chelkeba L, Melaku T. 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. Ann Clin Microbiol Antimicrob 2021; 20 (01) 33
    CrossrefPubMedSearch in Google Scholar
  • 25 Gupta P. A study of postoperative wound infection among post-surgical patients at Calicut medical college, Kerala, India. J Evol Med Dent Sci 2012; 1: 582
    CrossrefSearch in Google Scholar
  • 26 Jain BK, Banerjee M. Surgical site infections and its risk factors in orthopaedics: a prospective study in teaching hospital of central India. IJRM 2013; 2: 110-113
    Search in Google Scholar
  • 27 Ramesh A, Dharini R. Surgical site infection in a teaching hospital. Clinico microbiological and epidemiological profile. Int J Biol Med Res 2012; 3: 2050-2053
    Search in Google Scholar
  • 28 Kono K, Arakawa K. Methicillin-resistant Staphylococcus aureus (MRSA) isolated in clinics and hospitals in the Fukuoka city area. J Hosp Infect 1995; 29 (04) 265-273
    CrossrefPubMedSearch in Google Scholar
  • 29 Udaya Shankar C, Harish BN, Umesh Kumar PM, Navaneeth BV. Prevalence of methicillin resistant Staphylococcus aureus in JIPMER hospital - a preliminary report. Indian J Med Microbiol 1997; 15: 137-138
    Search in Google Scholar
  • 30 Giacometti A, Cirioni O, Schimizzi AM. et al. Epidemiology and microbiology of surgical wound infections. J Clin Microbiol 2000; 38 (02) 918-922
    CrossrefPubMedSearch in Google Scholar
  • 31 Manyahi J, Matee MI, Majigo M, Moyo S, Mshana SE, Lyamuya EF. Predominance of multi-drug resistant bacterial pathogens causing surgical site infections in Muhimbili National Hospital, Tanzania. BMC Res Notes 2014; 7 (01) 500
    CrossrefPubMedSearch in Google Scholar