Epidemiology, risk factors and microbiological profile of surgical site infections in emergency surgeries
DOI:
https://doi.org/10.18203/2349-2902.isj20262461Keywords:
Surgical site infection, Wound infection, Emergency laparotomy, AntibiogramAbstract
Background: Surgical site infections (SSIs) remain a major cause of postoperative morbidity, prolonged hospitalization, and increased healthcare expenditure. Identification of risk factors and local microbial patterns is essential for effective prevention and management. The objectives of this study are to evaluate the incidence of surgical site infections (SSI) in emergency surgical patients, identify associated risk factors, and analyze the bacteriological profile and antimicrobial susceptibility patterns of the isolated organisms.
Methods: A prospective observational study was conducted in the Department of General Surgery, Postgraduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana. A total of 150 adult patients who underwent emergency surgery and subsequently developed wound-related complications were included. Patients were followed for 30 days postoperatively. Clinical, demographic, and perioperative variables were recorded. Wound swabs were subjected to microbiological culture and antibiotic susceptibility testing. Statistical analysis was performed using SPSS version 21.0.
Results: The mean age of patients was 41.46±17.93 years, with males constituting 72.7% of cases. Culture positivity was observed in 67 patients, of whom 76% yielded Gram-negative organisms and 24% Gram-positive organisms. Escherichia coli (14.7%) was the most common isolate, followed by Klebsiella spp. (12.7%). Gram-negative isolates demonstrated high resistance to fluoroquinolones and third-generation cephalosporins, while piperacillin-tazobactam and meropenem showed the best susceptibility profiles. Significant associations with SSI were observed for prolonged duration of surgery (p=0.003), blood transfusion requirement (p=0.024), and higher Southampton wound scores (p<0.001). Age, sex, comorbidities, body mass index, anemia, previous surgery, and type of surgery were not significantly associated with SSI.
Conclusions: Prolonged operative duration, blood transfusion, and higher Southampton scores were significant predictors of SSI. The predominance of multidrug-resistant Gram-negative organisms highlights the importance of institution-specific antibiograms and antimicrobial stewardship programs to optimize patient outcomes.
References
Williams NS, Bulstrode CJK, O’Connell PR. Bailey and Love’s short practice of surgery. 25th ed. London: Hodder Arnold; 2008: 32-48.
Awad SS, Palacio CH, Subramanian A, Byers PA, Abraham P, Lewis DA, et al. Implementation of a methicillin-resistant Staphylococcus aureus prevention bundle results in decreased MRSA surgical site infections. Am J Surg. 2009;198:607-10.
Anderson DJ, Kaye KS. Staphylococcal surgical site infections. Infect Dis Clin North Am. 2009;23:53-72.
Singh RK, Shakya P, Bhutani S. Role of serum cholesterol and albumin levels as risk factors for developing surgical site infection. Int J Acad Med Pharm. 2023;5:1271-8.
Doherty GM, Way LW. Current surgical diagnosis and treatment. 12th ed. New York: McGraw-Hill; 2006: 106–107.
Nichols RL. Preventing surgical site infections: a surgeon’s perspective. Emerg Infect Dis 2001;7:220-4.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Am J Infect Control. 1999;27:97-132.
Cheadle WG. Risk factors for surgical site infection. Surg Infect (Larchmt). 2006;7 Suppl 1:S7-11.
Setty NH, Nagaraja MS, Nagappa DH, Giriyaiah CS, Gowda NR, Naik RDL. Surgical site infections and associated factors in a government tertiary care teaching hospital in Mysore, Karnataka. Int J Med Public Health. 2014;4:171-5.
Cheng K, Li J, Kong Q, Wang C, Ye N, Xia G. Risk factors for surgical site infection in a teaching hospital: a prospective study of 1,138 patients. Patient Prefer Adherence. 2015;9:1171-7.
Mohan N, Gnanasekar D, Tk S, Ignatious A. Prevalence and risk factors of surgical site infections in a teaching medical college in the Trichy district of India. Cureus. 2023;15:e39465.
Durand F, Berthelot P, Cazorla C, Farizon F, Lucht F. Smoking as a risk factor for organ/space surgical site infection in orthopaedic surgery with implant materials. Int Orthop. 2013;37:723-7.
Park H, de Virgilio C, Kim DY, Shover AL, Moazzez A. Effects of smoking and different BMI cutoff points on surgical site infection after elective open ventral hernia repair. Hernia. 2021;25:337-43.
Shabanzadeh DM, Sørensen LT. Alcohol drinking does not affect postoperative surgical site infection or anastomotic leakage: a systematic review and meta-analysis. J Gastrointest Surg. 2014;18:414-25.
Alemayehu MA, Azene AG, Mihretie KM. Time to development of surgical site infection and its predictors among general surgery patients admitted at specialized hospitals in Amhara region, northwest Ethiopia: a prospective follow-up study. BMC Infect Dis. 2023;23:334.
Thapa B, Sutanto E, Bhandari R. Thickness of subcutaneous fat as a risk factor for incisional surgical site infection in acute appendicitis surgery: a prospective study. BMC Surg. 2021;21:1-6.
Mekhla, Borle FR. Determinants of superficial surgical site infections in abdominal surgeries at a rural teaching hospital in central India: a prospective study. J Fam Med Prim Care. 2019;8:2258-63.
Gottrup F. Prevention of surgical-wound infections. N Engl J Med. 2000;342:202-4.
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;47:761-7.
Narula H, Chikara G, Gupta P. Bacteriological profile and antibiogram of postoperative wound infections in a tertiary care hospital in western Rajasthan: a prospective study. J Fam Med Prim Care. 2020;9:2850-5.
Rajak R, Mandal NS. Evaluation of surgical site infection after elective surgeries at a tertiary care hospital. Cureus. 2023;15:e50844.
Dessie W, Mulugeta G, Fentaw S, Mihret A, Hassen M, Abebe E. Pattern of bacterial pathogens and their antimicrobial susceptibility isolated from surgical site infections at selected referral hospitals in Addis Ababa, Ethiopia. Int J Microbiol. 2016;2016:1-8.
Gelaw A, Gebre-Selassie S, Tiruneh M, Mathios E, Yifru S. Isolation of bacterial pathogens from patients with postoperative surgical site infections and possible sources of infection at the University of Gondar Hospital, northwest Ethiopia. J Environ Occup Sci. 2014;3:103-8.
Dagbey C, Kpozehouen A, Coulibaly D, Chigblo P, Avakoudjo J, Ouendo EM, et al. Prevalence and factors associated with surgical site infections in the university clinics of traumatology and urology of the National University Hospital Centre Hubert Koutoukou Maga in Cotonou. Front Public Health. 2021;9:629351.
Indian Council of Medical Research. Antimicrobial Resistance Surveillance Network Annual Report 2024. New Delhi: ICMR; 2024. Available at: https://mox.icmr.org.in/amrsn/. Accessed on 24 July 2026.
Indian Council of Medical Research. Antimicrobial Resistance Surveillance Network Annual Report 2022. New Delhi: ICMR; 2022. Available at: https://main.icmr.nic.in/content/amrsn-annual-reports. Accessed on 24 July 2026.
Gautam V, Thakur A, Sharma M, Singh A, Bansal S, Sharma A, et al. Molecular characterization of extended-spectrum β-lactamases among clinical isolates of Escherichia coli and Klebsiella pneumoniae from tertiary care hospitals in India. Indian J Med Res. 2019;149:208-15.
Soni M, Sharma M, Agrawal P, Kumar A, Patel S, Gupta V, et al. Antibiotic susceptibility pattern of Pseudomonas aeruginosa isolated from clinical samples in a tertiary care hospital. J Clin Diagn Res. 2018;12:DC10-3.
Goli HR, Nahaei MR, Rezaee MA, Hasani A, Samadi Kafil H, Aghazadeh M. Antibiotic resistance pattern of Pseudomonas aeruginosa in a tertiary care centre in South India. Indian J Med Microbiol. 2017;35:218-21.
Mohanty S, Behera B, Sahu S, Praharaj AK. Recent pattern of antibiotic resistance in Staphylococcus aureus clinical isolates in Eastern India and the emergence of reduced susceptibility to vancomycin. Journal of Laboratory Physicians. 2019;11(04):340-5.
Rajaduraipandi K, Mani KR, Panneerselvam K, Mani M, Bhaskar M, Manikandan P. Prevalence and antimicrobial susceptibility pattern of methicillin-resistant Staphylococcus aureus. Indian J Med Microbiol. 2006;24:34-8.
Praharaj I, Sujatha S, Parija SC. Phenotypic & genotypic characterization of vancomycin resistant Enterococcus isolates from clinical specimens. Indian J Med Res. 2013;138(4):549-56.
Higgins RM, Helm MC, Kindel TL, Gould JC. Perioperative blood transfusion increases risk of surgical site infection after bariatric surgery. Surg Obes Relat Dis. 2019;15:582-7.
Janugade HB, Kshirsagar AY, Kanase VV. Significance of the Southampton wound grading system in surgical site infections. J Adv Zool. 2023;44:888.
Reji RG, Vijayakumar C, Sreenath GS. Surgical site infections in elective and emergency general surgery cases in a tertiary public hospital of South India: a retrospective study. Int Surg J. 2024;11:1091-6.
Selvaraj S, Rathinam TVP, Chandrahausan A, Srinivasan S. Post-surgical wound infections in a tertiary care hospital in Kanchipuram. J Evol Med Dent Sci. 2016;5:1180-3.
Anvikar AR, Deshmukh AB, Karyakarte RP, Damle AS, Patwardhan NS, Malik AK, et al. A one-year prospective study of 3,280 surgical wounds. Indian J Med Microbiol. 1999;17:129-32.
Downloads
Published
How to Cite
Issue
Section
