Risk factors, bacteriological profile and outcome of surgical site infections following orthopaedic surgery

Abstract

Background and Objectives: Surgical site infection (SSI) is a challenge for the surgeon. Incidence of SSI reported in literature varies from 0.5% to 15%. Severity of SSI ranges from superficial skin infection to life-threatening condition like septicaemia. It is responsible for increased morbidity, mortality, and economic burden to the hospital in general, and the patient in particular. The aim of this study was to assess the risk factors, bacteriological profile, length of hospitalization, and cost due to orthopaedic SSI in patients admitted to a tertiary care hospital.
 Materials and Methods: This was a prospective case control study. Cases were diagnosed based on CDC definition of nosocomial SSI. All cases were assessed preoperatively, intraoperatively and postoperatively, according to type of surgery, wound class, duration of operation, antimicrobial prophylaxis, use of drain, preoperative hospital stay, causative micro organism, total hospital stay, re-admission rates and cost incurred. Age, sex and surgical procedure matched controls without SSI, were also assessed. Chi- square test and Fisher's exact test were used for analysis. P= <0.05 was considered significant.
 Results: Out of 1023 patients, 47 cases had SSI, with a rate of 4.6%. Cigarette smoking was a risk factor for SSI (P = 0.0035). The most common etiologic agents were Acinetobacter baumannii and Staphylococcus aureus. Incidence of re- admission among SSI cases was more compared to controls (P= 0.0001). Costs attributable to SSI (Indian Rupees) was Rs 32,542 (17,054 to 87,514) which was significantly more than those without SSI (P= <0.001).
 Conclusion: Despite latest surgical amenities, meticulous sterilization protocols and pre-operative antibiotic prophylaxis, SSI continues to be present in healthcare settings. The increase in duration of hospital stay due to SSI adds to additional burden to an already resource-constrained healthcare system.

Current pathogens infecting open fracture tibia and their antibiotic susceptibility at a tertiary care teaching hospital in South East Asia

“…A review article on hospital-acquired infection from Singapore has reported that nosocomial infections are a significant issue worldwide, ranging from 5-10 % in European countries to more than 40% in Asia [ 29 ]. Like previous works increasing age, smoking, multiple co-morbidities, application of external fixator or wound closure at 1st surgery, failure to cover the wound within 5 days, higher Gustilo grade were significant risk factors for ultimate wound infection but alcoholism was not a risk factor in our analysis [ 30 , 31 ]. Our country has an extremely low rate of alcohol consumption [ 32 ].…”

Microbiological Profile and Drug Resistance Analysis of Postoperative Infections following Orthopedic Surgery: A 5-Year Retrospective Review

“…Advances in Orthopedics e incidence of orthopedic-related postoperative infections in the literature ranges from 2.5% to 41.9% [11,[16][17][18][19][20][21][22][23]. Comparable rates were found in developing countries, such that in a study conducted on 3096 orthopedic patients at a university hospital in Saudi Arabia, the incidence was found to be 2.55% [24].…”

A study on clinico-demographic and microbiological profile of surgical site infection (SSI) in a tertiary care hospital, Kolkata: An alarming trend

“…7 The risk factors of SSI are patient-related (e.g., pre-existing infection, elderly age), procedure-related and operative environment-related (e.g., emergency surgery, inadequate antiseptic surgical site preparation, air quality of OT). 8,9 Surgery in patients with poly-trauma, hemodynamic instability and patients who develop postoperative hypothermia, hypoxia, hyperglycaemia are prone to develop SSI. 10 Surgical site infection (SSI) surveillance is an important part of hospital infection control practice.…”