INCIDENCE OF SURGICAL SITE INFECTIONS, THEIR ETIOLOGY, ASSOCIATED ANTIMICROBIAL USE AND ANTIMICROBIAL RESISTANCE IN A TERTIARY CARE CENTRE IN NORTHERN INDIA.
Asfia Sultan*, Meher Rizvi, Fatima Khan, Sana Ali, Indu Shukla, Abida Khatoon
Introduction: Surgical site infections are third most commonly reported nosocomial infection. Reported surgical
site infection rate in India has varied from a low of 2.5% to a high of 41.9% over a period of decades. Material and
Methods: This study was done on patients who underwent major operative procedures between 21 Jan to 26 August
2011. Total 2536 cases were operated, of these 228 (8.99%) cases developed SSI. Ceftriaxone, Amikacin and
Metronidazole were most commonly used antimicrobial agents during preoperative and postoperative periods.
Wound status was assessed according to Southampton Scoring. Samples were collected by proper aseptic
techniques. Quality of specimen was assessed by Q-score. Culture and sensitivity was done as per standard
microbiological procedures. ESBL, AmpC, MBL, MRSA, HLAR were detected. Results: Of 228 cases, 60% cases
were contaminated, 3.6% dirty and 36.4% clean wounds respectively. 72.7% cases had superficial SSI while 34.5%
had deep SSI. According to Southampton scoring, 56.4% were classified under grade IV (purulent discharge along
wound), 34.5% cases grade V (wound dehiscence), 7.2% grade III (prolonged serous discharge) while 2% were
grade II (tender localised swelling). Polymicrobial etiology was observed in 17 and monobacterial in 211 cases. The
main pathogens being gram-positive bacteria (51.7%). S. aureus (46.5%) being the most common organism
followed by E. coli (32.0%), Citrobacter spp (9.6%). Among patients falling under Southampton grade IV & V,
Citrobacter sp (30.0%) dominated followed by E. coli (18.1%), S. aureus (16.3%). Among these 30% were ESBL
and 64.7% were AmpC producers while 39.6% were MRSA strains. No MBLs were detected. Conclusion:
Coryneforms exhibited maximum resistance with majority sensitive to only vancomycin. Maximum drug resistance
was observed in Grades IV and V SSI.
Keywords: Multidrug resistance, surgical site infection, southampton scoring.
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