PREVALENCE OF SURGICAL SITE INFECTION IN ORTHOPEDIC SURGERY: A 3-YEAR ANALYSIS IN BANGLADESH

Malay Kumar Saha*, Md. Zakir Hossain, Joyosree Paul, Chitta Ranjan Debnath, Mohammad Jahangir Alam and Md. Rezaul Karim

ABSTRACT

Introduction: 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. Surgical site infection (SSI) is disastrous in orthopedic practice as it is difficult to rid the bone and joint of the infection. Objective: To assess the prevalence of SSI in orthopedic practice and to identify risk factors associated with surgical site infections. Methods and Materials: All patients admitted to the National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR) Dhaka, Bangladesh & dept. of orthopaedic surgery ward, Mymensingh Medical College & Hospital, Mymensingh, Bangladesh between January 2017and December 2019, male & female were included in the study group. The data, which were collected from the medical charts and from the QuadraMed patient filing system, included age, sex, date of admission, type of admission (elective versus emergency), and classification of fractures. Analyses were made to find out the association between infection and risk factors, the v2 test was used. The strength of association of the single event with the variables was estimated using Relative Risk, with a 95% confidence interval and P<0.05. Results: A total of 101 of 2700 patients who had orthopedic or trauma operations contracted an SSI. The incidence of SSI was 3.74%. In all, 728 clean and elective operations were performed. During the study period, 101 SSI were detected, and the overall prevalence rate was 13.87%. There were 76 males and 25 females with an average age of 38.13±19.1 years. The demographic data are given. 71 patients were admitted directly to the orthopedic wards, 16 were transferred from the surgical intensive care unit and 14 from the surgical wards. Eighty three patients (83.1%) had various complications, and 3 patients (2.97%) died directly as a result of uncontrolled septicemia. The most common infective organism MRSA 27 patients (26.73%), Acinetobacter species in 21 (20.79%), Pseudomonas species in 19 (18.81%), and Enterococcus species in 16 (15.84%). 83 patients (82.1%) cultured a single organism, 15 had 2 infecting organisms, and 3 patients cultured more than 2 organisms. In all patients who had 2 or more organisms, Acinetobacter species was the common organism. Conclusion: SSI was found to be common in our practice. Emergency surgical procedures carried the greatest risk with Staphylococcus species and Acineto-bacter species being the common infecting organisms.

Keywords: Surgical Site Infection, Orthopedic Surgery, Trauma.