ASSOCIATION BETWEEN SERUM TOTAL CHOLESTEROL LEVELS AND NOSOCOMIAL INFECTIONS AFTER GASTROINTESTINAL SURGERY

Dr. Tanveer Ahmed*, Dr. Mohammad Tawfik Aziz Shaon, Dr. Md. Saidul Anwar, Dr. Akram Hossain Khan, Dr. Md. Ashraful Islam and Dr. Md. Khalilur Rahman Khabir

ABSTRACT

Introduction: Infection occurring in a patient in a hospital or other healthcare facilities in whom the infection was not present or incubating at the time of admission is known as Nosocomial infection. This includes infections acquired in hospital but appearing after discharge and also occupational infections among staff of the facility. It is a very serious complication and associated with increased mortality, morbidity increased treatment cost. There is a relationship between Nosocomial infection and Serum total cholesterol level. Hypercholesterolemia is protective though it may cause several cardiovascular diseases. Circulating cholesterol-rich lipoproteins and triglyceride-rich lipoproteins have the capacity to bind and detoxify bacterial lipopolysaccharide (LPS). HDL has been shown to compete with LPS binding protein (LBP) for binding to LPS. Methods: This study was an observational study which was conducted at surgery department of Dhaka Medical College & Hospital, over a period of one year between November 2016 to November 2017. All admitted patients underwent gastrointestinal surgery were included in this study. A purposive sampling technique was applied to select the study sample. Main outcome variables were Superficial and deep SSI, Organ space SSI, Pneumonia, UTI. Serum albumin level, Total cholesterol level, Preoperative diagnosis, Site of operation, Operation time, Blood loss, Blood transfusion, Hospital stay, Age, Sex, Smoking were other independent variables. Data processing and analysis were done using SPSS (statistical package for social sciences), version 20. The test statistics used to analyze the data are cross sectional statistics. The summarized data were presented in the form of tables with due statistical interpretation. Statistical significance were determined by Chi-square Test (x2). Results: Among 150 patients 130 (86.7%) were below 60 years of age and 20 (13.3%) were above 60 years of age. Mean age was 44 years and standard deviation was 13. Among the 150 patients 98 (65.3%) were male and 52 (34.7%) were female in this study the overall incidence of Nosocomial infection was found 36.7% (n =55). Among them most commonly found infection was Superficial & Deep SSI 20.7% (n = 31) and least incidence was found in case of Pneumonia, only 06 cases was found which was about 4%. In case of Organ space infection incidence was 5.3% (n=08) and Urinary tract infection was found 6.7% (n=10). Overall postoperative mortality occurred within 60 days of operation was 5.3% (n=8) which was statistically significant in case of Organ space infection (P <0.05). Lowest quartile (<159 mg / dl) of total serum cholesterol level (45.8%, n= 11, P <0.05), low serum albumin level (< 4 mg / dl) and operation time (121- 300 min) and preoperative diagnosis were found independent predictors of development of superficial and deep SSI. About 17 (29.3%) cases were found infected, those who have serum albumin level within (3.2- 3.5 mg /dl) and P value was <0.05. Smoking, Serum total cholesterol level, Preoperative diagnosis and operation time were found strong predictors for development of nosocomial infection. Among 76 smoker cases only eight patients were found infected (P = .006). About 16.7 % (n= 04) patients were found having total cholesterol level < 159 mg/dl (P = .049). Six patients were infected with pneumonia among this 04 were aged more than 60 years (P = .003). None of preoperative variables were associated with development with UTI except age of the patients. Conclusion: Low serum total cholesterol level, low serum albumin level, prolong operation time, Malignant cases and smoking are significantly associated with postoperative nosocomial infection. Nosocomial infections are associated with prolong hospital stay and mortality.

Keywords: Hypercholesterolemia, nosocomial infection, Serum total cholesterol level.