DOI: https://dx.doi.org/10.18203/2349-2902.isj20222938
Published: 2022-10-29

Incidence of surgical site infection in patients undergoing clean, clean contaminated cases with respect to antibiotic prophylaxis: a prospective observational study

Shravani M. Shetye, Manmohan Kamat, Neeraj P. Singh

Abstract


Background: Surgical site infection (SSI) is the most surveyed and frequent type of healthcare associated infection in low-middle income countries. With the advent of antibiotics its incidence has been decreased but prolonged use of prophylactic antibiotics in clean and clean contaminated surgeries has increased substantial burden on healthcare system.

Methods: This is a single centric, prospective, observational study. In the period over 12 months, patients which were admitted for elective clean, clean contaminated surgeries were assessed preoperatively, intraoperatively and postoperatively. The patients in the study group received 1 dose of prophylactic antibiotic in clean cases and 3 doses in clean-contaminated cases according to the protocol and control group patients didn’t follow this criterion.

Results: Incidence of SSI is 2.26% in study group, which was not significantly high compared to control group which was 1.97. Incidence of superficial SSI is higher in both study and control group as compared to deep SSI. The most common isolate from wound culture was Staphylococcus aureus. Also strain of E. coli, sensitive strain of Pseudomonas and resistant strain of Klebsiella pneumonia were isolated.

Conclusions: Irrational use of prophylactic antibiotics in clean and clean contaminated cases is not beneficial and just adding the cost and increasing the chances of development of antibiotic resistant strains.


Keywords


Surgical site infections, Antibiotic prophylaxis, Clean surgeries, Clean contaminated surgeries, Healthcare associated infections

Full Text:

PDF

References


WHO document on Global Guidelines for the Prevention of Surgical Site Infection; WHO Guidelines Development Group; Geneva, Switzerland. 2016;58-177.

Darouiche R. Surgical site infecctions. Infectious disease advisor. 2019. Available at: https://www.infectiousdiseaseadvisor.com/home/decision-support-in-medicine/hospital-infection-control/surgical-site-infections/. Accessed on 24 June 2022.

Curcio D, Cane A, Fernández F, Correa J. Surgical site infection in elective clean and clean-contaminated surgeries in developing countries. Int J Infect Dis. 2019;80:34-45.

Arora A, Bharadwaj P, Chaturvedi H, Chowbey P, Gupta S, Leaper D, et al. A review of prevention of surgical site infections in Indian hospitals based on global guidelines for the prevention of surgical site infection. J Patient Saf Infect Control. 2018;6:1-12.

Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis. 2014;59(2):147-59.

Aiken A. Antibiotic prophylaxis for prevention of surgical site infection (SSI); KEMRI-Wellcome trust research programme, Kenya. Available at: https://onehealthtrust.org/wp-content/uploads/2017/06/dr_alex_aiken_0-2.pdf. Accessed on 24 June 2022.

Berríos-Torres SI, Umscheid CA, Bratzler DW. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection. JAMA Surg. 2017;152(8):784-91.

Surgical site infections: prevention and treatment; NICE guideline [NG125]. 2019. Available at: https://www.nice.org.uk/guidance/ng125. Accessed on 24 June 2022.

Lilani SP, Jangale N, Chowdhary A, Daver GB. Surgical site infection in clean and clean-contaminated cases. Indian J Med Microbiol. 2005;23(4):249-52.

Ortega G, Rhee DS, Papandria DJ, Yang J, Ibrahim AM, Shore AD, Makary MA, Abdullah F. An evaluation of surgical site infections by wound classification system using the ACS-NSQIP. J Surg Res. 2012;174(1):33-8.

Kumar K, Kulkarni SR, Gayatri, Tripathi SV, Puppal AN. Surgical site Infection in Clean, Clean-Contaminated and Contaminated Cases. J Med Sci Clin Res. 201;4(12).

Mioton LM, Jordan SW, Hanwright PJ, Bilimoria KY, Kim JY. The Relationship between Preoperative Wound Classification and Postoperative Infection: A Multi-Institutional Analysis of 15,289 Patients. Arch Plast Surg. 2013;40(5):522-9.

Prestinaci F, Pezzotti P, Pantosti A. Antimicrobial resistance: a global multifaceted phenomenon. Pathog Glob Health. 2015;109(7):309-18.