A prospective study on pattern of superficial surgical site infections in patients undergoing emergency laparotomy for perforation peritonitis

Mayank Singh, Ratika Agarwal, Rahul Singh


Background: surgical site infections (SSIs) are recognized as a common surgical complication occurring in about 3% of all surgical procedures and in upto 20% of patients undergoing emergency intraabdominal procedures. Aims: To determine the incidence of SSIs in emergency laparotomies done for perforation peritonitis and the organisms involved and their sensitivity pattern in superficial SSI. The objective of the study was to determine the effect of planned intra operative intervention [antibiotic lavage with III generation cephalosporin e.g. ceftriaxone 1 gm and metronidazole 100 ml (5 mg per ml)] on superficial surgical site infection in emergency laparotomies done for perforation peritonitis.

Methods: This prospective randomized case controlled study was carried out in P. G. Department of Surgery, S. R. N. Hospital associated with M. L. N. Medical College, Allahabad, from September 2018 to August 2019 after approval from the ethical committee and after obtaining written and informed consent either from patient or their guardian. Patients were divided into two groups viz. control group receiving the normal saline lavage and case group receiving the antibiotic lavage (III generation cephalosporins i.e., ceftriaxone (1 gm in 1000 ml NS) and metronidazole- 5 mg/ml (100 ml in 500 ml NS).

Results: There is almost 50% incidence of SSI in emergency laparotomy done for perforation peritonitis. The most common organism involved in superficial SSI in present study was gut flora (E. coli) followed by normal skin colonizer (Staph. aureus).

Conclusions: Intraperitoneal antibiotic lavage has a significant role in reducing the rate of SSI especially in gastroduodenal perforations.


Cephalosporin, Surgical site infection, Perforation peritonitis

Full Text:



LakshmiPriya R, Bhoyate AA, Lokesh. S, Singh KG, Sharma KL. Surgical site infections–incidence, risk factors and microbiological pattern–study from North East India. Organ. 2018;17:23-8.

Barie PS, Eachempati SR. Surgical site infections. Surg Clin. 2005;85(6):1115-35.

Chatterjee S, Khaitan A, Bhattacharya S, Samanta S, Saha AK. Prospective study of surgical site infection in laparotomy wounds with antibiotic lavage. Int Surg J. 2016;3(4):2221-6.

Alkaaki A, Al-Radi OO, Khoja A, Alnawawi A, Alnawawi A, Maghrabi A, et al. (2019). Surgical site infection following abdominal surgery: a prospective cohort study. Canadian J Surg. 2019;2(2):111-7.

Lawson EH, Hall BL, Ko CY. Risk factors for superficial vs deep/organ-space surgical site infections. JAMA Surg. 2013;148(9):849.

Leaper DJ. Risk factors for and epidemiology of surgical site infections. Surg Infect (Larchmt). 2010;11:283-7.

Ballus J, Lopez-Delgado JC, Sabater-Riera J, Perez-Fernandez XL, Betbese AJ, Roncal JA. Surgical site infection in critically ill patients with secondary and tertiary peritonitis: epidemiology, microbiology and influence in outcomes. BMC Infec Dis. 2015;15(1).

Kumar P, Singh K, Kumar A. A comparative study between Mannheim peritonitis index and APACHE II in predicting the outcome in patients of peritonitis due to hollow viscous perforation. Int Surg J. 2017;4(2):690-6.

Jhobta R, Attri A, Kaushik R, Sharma R, Jhobta A. World J Emer Surg. 2016;1(1):26.

Gupta A, Sachan PK, Agrawal S. Predicting the outcome of perforation peritonitis by using apache II scoring system. Int Surg J. 2018;5(2):402-6.

Abdul Basith PT, Konnakkodan SM. Surgical factors affecting superficial surgical site infections in laparatomy incisions. J Med Sci Clin Res. 2019;7(4):62-4.

Latham R, Lancaster AD, Covington JF, Pirolo JS, Thomas CS. The association of diabetes and glucose control with surgical-site infections among cardiothoracic surgery patients. Infect Control Hospital Epidemiol. 2001;22(10):607-12.

Santhosh CS, Chandra SA, Shetty KK. Efficacy of imipenem lavage versus saline lavage in perforation peritonitis. Int Surg J. 2018;5(6):2148-53.