Postoperative surveillance of port site infection in laparoscopic cholecystectomy: identification of pathogens and antibiotic resistance trends in tertiary care hospitals of Peshawar

Izaz Ahmad Khan; Muhammad Waleed; Anas Muiz Jehan; Muhammad Wasif Abdullah; Ibqar Azeem; Afrasayab Khattak; Muhammad Zain Ul Abidin; Muhammad Fawad Liaqat Orakzai; Hafiz Abdullah Sadiq; Owais Qarni

doi:10.18203/2349-2902.isj20263838

Authors

Izaz Ahmad Khan Department of Surgery, Peshawar Medical College, Peshawar, Pakhtunkhwa, Pakistan https://orcid.org/0009-0005-3754-7450
Muhammad Waleed Department of Surgery, Peshawar Medical College, Peshawar, Pakhtunkhwa, Pakistan https://orcid.org/0009-0000-7958-339X
Anas Muiz Jehan Department of Surgery, Peshawar Medical College, Peshawar, Pakhtunkhwa, Pakistan https://orcid.org/0009-0009-1602-0907
Muhammad Wasif Abdullah Jinnah Medical College https://orcid.org/0009-0001-3642-3326
Ibqar Azeem Department of Surgery, Peshawar Medical College, Peshawar, Pakhtunkhwa, Pakistan https://orcid.org/0000-0002-7887-2189
Afrasayab Khattak Department of Surgery, Peshawar Medical College, Peshawar, Pakhtunkhwa, Pakistan https://orcid.org/0009-0008-8128-9112
Muhammad Zain Ul Abidin Department of Surgery, Peshawar Medical College, Peshawar, Pakhtunkhwa, Pakistan
Muhammad Fawad Liaqat Orakzai Department of Surgery, Peshawar Medical College, Peshawar, Pakhtunkhwa, Pakistan https://orcid.org/0009-0008-4817-0099
Hafiz Abdullah Sadiq Department of Surgery, Peshawar Medical College, Peshawar, Pakhtunkhwa, Pakistan https://orcid.org/0009-0001-6304-9763
Owais Qarni Department of Surgery, Peshawar Medical College, Peshawar, Pakhtunkhwa, Pakistan https://orcid.org/0009-0009-3914-809X

DOI:

https://doi.org/10.18203/2349-2902.isj20263838

Keywords:

Port site infection, Laparoscopic cholecystectomy, Antibiotic resistance, Surgical site infection

Abstract

Background: Port-site infection (PSI) is a frequent but poorly defined post-laparoscopic cholecystectomy (LC) complication, the most common surgical procedure for the treatment of symptomatic cholelithiasis. Increasing antimicrobial resistance of the causative organisms poses a risk to postoperative outcomes, especially in resource-limited areas where there is limited local pathogen and resistance data.

Methods: The study was conducted in the tertiary care hospitals of Peshawar, Khyber Pakhtunkhwa, Pakistan for six months (May–November 2025) using a cross-sectional study design. A purposive sampling method was used to recruit 95 patients aged ≥18 years who developed PSI within 7 days after LC, excluding patients with pre-existing infections or immunocompromising conditions. Patients were followed up at 48 hours, 1 week and 2 weeks after surgery. Microbiological culture and sensitivity were done on wound swabs of suspected infections. The data were analyzed by chi-square test, Mann-Whitney U test and Kruskal-Wallis test in SPSS-25.

Results: The mean patient age was 50.5±18.1 years (51 male, 44 female). PSI occurred in 85 patients (89.5%). The most common isolates were Staphylococcus aureus (36.5%), E. coli (27.1%), Klebsiella pneumoniae (21.2%), Pseudomonas aeruginosa (10.6%) and Proteus mirabilis (4.7%). High sensitivity was observed for levofloxacin, meropenem, vancomycin, linezolid and imipenem, and the highest resistance was observed for clindamycin (85.9%). There was no significant association between PSI and gender (p=0.210) or bile spillage (p=0.083). Patients with infection were significantly more likely to be hospitalized for longer than non-infected patients (median 6 days vs 2 days, p<0.001), and Klebsiella and Pseudomonas infections were associated with the longest hospital stay and the highest rates of persistent infection and re-intervention.

Conclusions: Gram-positive and gram-negative organisms make significant contributions to PSI following LC, and have different resistance patterns and clinical outcomes. To minimize morbidity, targeted antibiotic stewardship based on local resistance data is crucial.

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