Prevalence and root causes of surgical site infections at an academic trauma and burn center in Ethiopia: a cross-sectional study

Abstract

Background: Despite modern surgical techniques and the use of antibiotic prophylaxis, surgical site infection remains a burden for the patient and health system. It is a major cause of morbidity, prolonged hospital stay, and increased health costs. Thus, the main aim of this study was to determine the prevalence and root causes of surgical site infection among patients undergoing major surgery at an academic trauma and burn center in Ethiopia. Methods: A hospital based cross-sectional study was conducted on 249 patients during 6-months' time window. Data entered in SPSS and multivariate logistic regression was employed to determine the root causes and the outcome variable. Results: The prevalence of surgical site infection was found to be 24.6% of whom 10% develop deep site, 9.2% organ spaced and the remaining 5.2% develop superficial space surgical site infection. The prevalence was high in patients who had undergone orthopedics (54.3%) and abdominal (30%) surgeries. Educational status, pre-morbid illness, duration of pre-operative and post-operative hospital stay, ASA score, and type of the wound were significantly associated with SSI at p-value of ≤0.05. However, no association was found with BMI and location of the wound. Conclusions: The prevalence of surgical site infection in the study population is still high. Preoperative hospital stay, pre-morbid illness, pre-operative and post-operative hospital stay, ASA score, and type of the wound were the independent predictors of surgical site infection. The duration of pre and post-operative periods should be kept to a minimum as much as possible. Patients with pre-morbid history of chronic diseases and contaminated wound require special attention to decrease the rate of occurrence of infections. In addition, longitudinal studies should be carried out to identify more risk factors.

<p>Surgical Site Infections and Prophylaxis Antibiotic Use in the Surgical Ward of Public Hospital in Western Ethiopia: A Hospital-Based Retrospective Cross-Sectional Study</p>

“…In our study, 14.7% SSIs were superficial, followed by deep (3%) infections, which is different from Mezemir et al, 39 study that reported 40.7% and 37.4% were deep and organ spaced infections, respectively. In addition, a higher percentage of surgical procedures were general (39.1%).…”

“…Besides, contaminated and dirty wound classes were six and seven times more susceptible to SSIs than clean wound classes. This finding is in line with Weldu et al, 46 Mezemir et al, 39 and Misganaw et al 28 studies. These types of wound classes are suitable for the colonization and multiplication of different pathogens.…”

“…Nonetheless, the prevalence was lower than studies conducted by Misganaw et al (23.4%) 28 and Mezemir et al (24.6%). 39 In addition, it was lower than the recent systematic review performed in Ethiopian literature (25.22%, 95% CI: 17.30–3.14%). 40 This disparity could probably be due to the higher prevalence of prophylactic surgical antibiotic use (88.6%) in our setting.…”

<p>Evaluation of Surgical Antimicrobial Prophylaxis and Incidence of Surgical Site Infection at Borumeda Hospital, Northeast Ethiopia: Retrospective Cross-Sectional Study</p>

“…These were also identified by other studies to be independent predictors of SSI. 11,54,[58][59][60] Patients who received postoperative prophylaxis for greater than 24 h after surgery had 3.5 times higher risk of developing SSI than those whose postoperative prophylaxis discontinued within 24 h after surgery. This can be attributed to the fact that prolonged use of prophylactic antimicrobials is associated with the emergence of resistant bacterial strains and the excess use of antimicrobials can contribute to secondary infections, such as those caused by Clostridium difficile.…”

Incidence and root causes of surgical site infections after gastrointestinal surgery at a public teaching hospital in Sudan

“…The risk of SSI is related to the level of contamination of the wound as demonstrated in a recent surveillance of surgical infections in NHS hospitals in England, which showed that the SSI risk following gastrointestinal tract procedures (especially large bowel surgery) reached 9.0% in 2018/19 [9]. While SSIs could be prevented by identifying and mitigating the predisposing factors, SSIs still have a significant burden on both the patient and health system in Sub Saharan Africa countries, where resources are limited, and the wound infection rates are higher than developed countries [10,11]. Moreover, there is a knowledge gap regarding SSIs incidence, related factors and microorganism in Sudan.…”