Surgical Site Infections; A Study of Incidence, Risk Factors and Causative Organisms in Emergency Abdominal Surgeries

Abstract Background Surgical site infection (SSI) is the most commonly reported nosocomial infection. Surgical site infections are responsible for increase in cost, morbidity, and mortality related to surgical operations. Surveillance with information feedback to surgeons and other medical staff has been shown to be an important element in the overall strategy to reduce the numbers of SSIs. Objectives To determine the incidence and factors responsible for, causative micro-organisms and effective antibiotics for surgical site infections following emergency abdominal operations. Patients and methods a total of 252 patients were enrolled in the current study and were retrospectively followed till the tenth day post-operatively. Data collection sheets were filled in for all the patients. If any symptom or sign of infection appear during this period then proper investigation was instituted for the diagnosis of infection and to assess the type and severity of the infection. If any collection of pus identified it was drained out and sent for culture and sensitivity test. Proper antibiotic was given to every patient both preoperative and post-operative periods. Antibiotic was changed where necessary after getting the report of culture and sensitivity test. Results Surveillance of SSIs in the current study revealed an SSI incidence of 21.4%. The most frequent organisms detected by wound swab cultures were E. coli (55.5%), followed by Klebsiella and coagulase negative staphylococci, with the emergence of resistant strains like MDR, AMPC, ESBL strains. Sensitivity to antiobiotics showed Colistin, Polymyxin B, Vancomycin and Tigecycline to be fully functional, next in sensitivity was piperacillin tazobactam, then meropenem, followed by imipenem and amikacin. SSI was found to be increased with the advancement in age, Smoking cigarettes and HCV positive cases. The fourth post-operative day was the commonest day for the occurrence of SSI with discharge from the wound being the most prevalent sign. Conclusion A surveillance system for SSI with feedback of appropriate data to surgeons and hospital authorities is highly recommended to reduce the SSI rate General Surgical Departments at Ain Shams Specialized Hospital - Police Hospital and other Departments as well.

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Bacteriological profile and antibiotic sensitivity pattern in patients with Urinary tract infection

Journal of Pathology of Nepal ◽

10.3126/jpn.v7i1.16910 ◽

2017 ◽

Vol 7 (1) ◽

pp. 1066-1069 ◽

Cited By ~ 1

Author(s):

N Subedi ◽

S Pudasaini

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Urine Culture ◽

Antibiotic Sensitivity ◽

Sensitivity Test ◽

Age Group ◽

E Coli ◽

Bacteriological Profile ◽

Culture And Sensitivity ◽

Culture Positive

Background: Urinary tract infection is one of the common bacterial infections seeking treatment in clinical practice. A variety of organisms are associated with UTI and the most common organisms are Escherichia coli and other coliforms. Bacteriological investigations of UTI are not complete without antibiotic sensitivity test of the isolate. The aim of this study is to determine the bacteriological profile and antibiotic sensitivity patterns and their disease association.Materials and methods: This study was conducted in Shankarapur Hospital over a period of one year. All cases of suspected UTI sent for urine culture and sensitivity test were evaluated in this study. Disease associated with UTI, bacteriological profile and antibiotic sensitivity patterns were evaluated.Results: A total of 974 cases were sent for urine culture and sensitivity test. The total culture positive cases were 165 (17.4%). The most common age group for culture positive test was 21- 30 years (33.3%) followed by 31- 40 years (25.5%). Female patients formed the majority of culture positive cases (84.8%) and E Coli (86.1%) was the most common organism isolated. Piperacillin- tazobactum and ceftriaxone were the most common antibiotic sensitive to the organisms. Simple uncomplicated UTI and PID were the most common indication for subjecting the patients to urine culture.Conclusion: UTI is most commonly seen in female of reproductive age group and the most common causative organism is E coli. Culture result and antibiogram helps the clinician for specific treatment of UTI.

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Antibiotic sensitivity pattern in urinary tract infection among adults in central part of Nepal

Journal of Chitwan Medical College ◽

10.3126/jcmc.v9i4.26894 ◽

2019 ◽

Vol 9 (4) ◽

pp. 18-23

Author(s):

Arun Sedhain ◽

Abja Sapkota ◽

Bidhan Shrestha

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Urine Culture ◽

College Teaching ◽

Sensitivity Test ◽

E Coli ◽

Common Organism ◽

Sensitivity Pattern ◽

Culture And Sensitivity

Background: Urinary tract infection (UTI) is characterized by pathological invasion of the urinary tract by microorganisms. Majorities of organisms causing UTI are gram negative bacteria, most common of which is E. coli. Urine culture and sensitivity test is used to isolate the organism and to identify the susceptible drug of choice for appropriate treatment. This hospital-based study was carried out to analyze the spectrum and antibiotic susceptibility of microorganisms causing UTI. Methods: A retrospective study was done to analyze the results of urine culture and sensitivity test done at Chitwan Medical College Teaching Hospital over a period of two and half years. Standard guideline and protocol were used to collect the urine sample and to perform the test. Data analysis was done using SPSS version 21.0. Result: Out of 12, 925 urine samples submitted for culture and sensitivity test during the study period, bacterial pathogens were isolated from 3, 173 (24.54%) samples, which was significantly higher among females (28%) than the males (17%). The most common organism isolated on the culture was E. coli (68.5%) followed by Klebsiella (18.4%). Sensitivity of the uropathogens was seen highest with colistin (79.2%) followed by teicoplanin (64.58%), Aztreonam (63.25%) and Nitrofurantoin (61.16%). Most common antibiotics that showed resistance to the microorganisms in this study were Ampicillin (60.93%), Cotrimoxazole (53.72%), Cefixime (40.57%) and Levofloxacin (32.93%). Conclusions: This study has found a usual pattern of UTI with higher prevalence among females and E. coli being the most common organism. Nitrofurantoin has been found to have a good susceptibility for the treatment of UTI.

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Surveillance of surgical site infections to determine incidence, risk factors and microbiologic spectrum following obstetric and gynaecological surgeries

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184124 ◽

2018 ◽

Vol 7 (10) ◽

pp. 4029

Author(s):

Seetha Panicker ◽

T. V. Chitra

Keyword(s):

Risk Factors ◽

Operating Time ◽

Surgical Site Infections ◽

Multidrug Resistant ◽

E Coli ◽

Incidence Risk ◽

Resistant Strains ◽

Prolonged Hospital ◽

Drug Resistant Strains ◽

Hospital Acquired

Background: Surgical site infections (SSI) are one of the major health problems throughout the world with an incidence of 3%-16%. Hospital acquired surgical site infection is further complicated by the emergence of multi drug resistant strains. SSI surveillance is an established monitoring tool and has been shown to reduce infection rates. The importance of preventing surgical site infections is well recognized since they lead to increased morbidity, prolonged hospital stay, need for readmission, high end antibiotic treatment and re-surgery. This study was undertaken to determine the incidence, risk factors, and microbiological spectrum of surgical site infections and to identify the multidrug resistant strains. Analysis of the effectiveness of the existing surveillance methods was also done.Methods: This retrospective study was done for a period of 1-year form Jan 2016 to Dec 2016. All patients with infection following caesarean section and abdominal and vaginal hysterectomy were included. Laparoscopic surgery and patients with preexisting infection were excluded.Results: Incidence of SSI in present study is 5.27%. The major risk factors identified were obesity, diabetes and prolonged operating time. The commonest infective organism was Klebsiella Pneumoniae in 37% of which 19% were ESBL producing and 3.8% were carbapenemase producing. E. coli was identified in 20% of isolates. The incidence of ESBL in both isolates was higher.Conclusions: Regular audit of SSIs is a very effective tool to analyse risk factors, identify causes and plan strategies to prevent infection.

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Pattern of surgical site infection in contaminated and infected wounds and corelation with introperative bacterial growth

Journal of Surgical Arts ◽

10.14717/jsurgarts-210104 ◽

2021 ◽

pp. 17-21

Keyword(s):

Wound Infection ◽

Surgical Procedures ◽

Bacterial Contamination ◽

Surgical Site Infections ◽

Wound Infections ◽

E Coli ◽

Increased Risk ◽

Infected Wounds ◽

Abdominal Operations ◽

Set Up

Surgical Site Infections (SSIs), previously called post operative wound infections, result from bacterial contamination during or after a surgical procedure.Surgical site infections are the third most common hospital associated infection, accounting for 14-16% of all infections in hospitalized patients. Aims and objectives are to establish the pattern of wound infection in terms of aerobic organisms after contaminated and infected surgical procedures. 50 patients having emergency or elective traumatic or non-traumatic abdominal operations who fulfil the criteria of infected and contaminated wounds are included in the study. Patients to be studied were selected in random basis. The incidence of wound infection is 31.57% in contaminated surgical procedures and 29.03% in infec-ted surgical procedure. Operation in emergency set up results in an increased risk of wound infection. Patients with positive intra operative bacteriology runs a higher risk of developing wound infection. The commonest organism isolated from intra operative swab cultures were E. coli followed by Klebsiella in both infected and contaminated procedures. Presence of polymicrobial flora in intraoperative swab culture is associated with hig-her rate of wound infection.

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Incidence and Etiology of Surgical Site Infections among Emergency Postoperative Patients in Mbarara Regional Referral Hospital, South Western Uganda

Surgery Research and Practice ◽

10.1155/2017/6365172 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Abubaker Lubega ◽

Bazira Joel ◽

Najjuka Justina Lucy

Keyword(s):

Klebsiella Pneumoniae ◽

Surgical Site Infections ◽

Referral Hospital ◽

Regional Referral Hospital ◽

E Coli ◽

Diffusion Technique ◽

Highly Sensitive ◽

Incidence Risk ◽

Causative Agents ◽

Western Uganda

Background. This prospective hospital based study was conducted to determine the incidence, risk factors, and causative agents of surgical site infection their susceptibility to among 114 emergency postoperative patients at the Mbarara Regional Referral Hospital between September 2014 and January 2015. Methods. Consented patients were consecutively enrolled and their preoperative, intraoperative, and postoperative data were collected. Follow-ups were done in the surgical outpatient clinics. Wound specimens were collected and processed as per Sops; susceptibility testing was done using the Kirby-Bauer disc diffusion technique. Data was analyzed using STATA 11.0. Results. Overall SSI incidence was 16.4%: 5.9% superficial and 47.1% deep and organ space SSIs each. Klebsiella pneumoniae was the most predominant organism (50%) followed by Staphylococcus aureus (27.8%). E. coli and P. aeruginosa both accounted for 11.1%. Wound class (p=0.009), anaemia (p=0.024), low serum albumin (p=0.046), and property of suture material used (p=0.006) were significantly associated with SSIs. All organisms had 100% resistance to ampicillin, tetracycline, septrin, and erythromycin. Ciprofloxacin and ceftriaxone are highly sensitive to all organisms. Conclusion. The incidence of SSI in this hospital is very high. Klebsiella pneumoniae is the predominant cause. Ciprofloxacin are very potent antibiotics against organisms that cause SSI.

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Factors predicting surgical site infection after clean contaminated surgery

International Surgery Journal ◽

10.18203/2349-2902.isj20175915 ◽

2017 ◽

Vol 5 (1) ◽

pp. 300

Author(s):

Ranjith Mannarakkal ◽

Mohammed Suaib ◽

Abidali Karatparambil ◽

Abhijith N. Das

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Prolonged Exposure ◽

Surgical Site Infections ◽

Prophylactic Antibiotics ◽

Site Infection ◽

E Coli ◽

Co Morbidity ◽

Abdominal Operations ◽

Clean Contaminated

Background: The infection of a wound is defined as the invasion of organisms through tissues following a breakdown of local and systemic host defences, leading to cellulitis, lymphangitis, abscess and bacteraemia. Southampton criteria and the centers for disease control and prevention criteria for the diagnosis of surgical site infections are used now for severity assessment. There is still controversy existing on the multifactorial causal relationship.Methods: Longitudinal Observational study with nonrandom purposive sampling carried out in the patients in OT, Casuality, ICU and Wards, in our hospital having clean contaminated abdominal operations for one-year period starting from November 2015 determine the factors responsible for surgical site infections following clean contaminated abdominal operations with prophylactic antibiotics(n=150).Results: Diabetes mellitus (odds ratio of 1.9) and emergency procedure (12.6%) were the most important risk factors for development of SSI. E. Coli (45%, n= 9) was the most common organism. Midline incision (n=6/22 = 27.27%) showed highest rate. Other high-risk factors are obesity, malnutrition, anemia, old age and prolonged duration of surgeries.Conclusions: Various host factors like malnutrition, obesity, patients knowledge about hygiene, presence of co-morbidity etc. coupled with environmental factors such as condition of the wounds, delay to initiate operation, duration of operation, prolonged exposure of peritoneal cavity to environment, prophylactic use of antibiotics and factors associated with surgery like type of incision, type of operation and experience of operating surgeon greatly contribute to occurrences of SSI. So, quality of surgical care including immediate assessment of patients, resuscitative measures, adequate preparation of patients and aseptic environment are important for control of SSI. Moreover, in absence of highly advanced surgical amenities, preoperative resuscitative units, modern operation theatre facilities and sophisticated sterilization procedure it is necessary to use prophylactic antibiotics to encounter the various types of micro-organisms responsible for surgical site infection, particularly E. coli.

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The Role of the Coagulase-negative Staphylococci (CoNS) in Infective Endocarditis; A Narrative Review from 2000 to 2020

Current Pharmaceutical Biotechnology ◽

10.2174/1389201021666200423110359 ◽

2020 ◽

Vol 21 (12) ◽

pp. 1140-1153 ◽

Cited By ~ 1

Author(s):

Mohammad A. Noshak ◽

Mohammad A. Rezaee ◽

Alka Hasani ◽

Mehdi Mirzaii

Keyword(s):

Foreign Body ◽

Infective Endocarditis ◽

Prosthetic Valve ◽

Human Life ◽

Prosthetic Valve Endocarditis ◽

Surgical Site Infections ◽

Coagulase Negative Staphylococci ◽

Native Valve ◽

Native Valve Endocarditis

Coagulase-negative staphylococci (CoNS) are part of the microbiota of human skin and rarely linked with soft tissue infections. In recent years, CoNS species considered as one of the major nosocomial pathogens and can cause several infections such as catheter-acquired sepsis, skin infection, urinary tract infection, endophthalmitis, central nervous system shunt infection, surgical site infections, and foreign body infection. These microorganisms have a significant impact on human life and health and, as typical opportunists, cause peritonitis in individuals undergoing peritoneal dialysis. Moreover, it is revealed that these potential pathogens are mainly related to the use of indwelling or implanted in a foreign body and cause infective endocarditis (both native valve endocarditis and prosthetic valve endocarditis) in patients. In general, approximately eight percent of all cases of native valve endocarditis is associated with CoNS species, and these organisms cause death in 25% of all native valve endocarditis cases. Moreover, it is revealed that methicillin-resistant CoNS species cause 60 % of all prosthetic valve endocarditis cases. In this review, we describe the role of the CoNS species in infective endocarditis, and we explicated the reported cases of CoNS infective endocarditis in the literature from 2000 to 2020 to determine the role of CoNS in the process of infective endocarditis.

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Prevalence of Antimicrobial-Resistant Pathogens in Canadian Hospitals: Results of the Canadian Ward Surveillance Study (CANWARD 2008)

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00469-10 ◽

2010 ◽

Vol 54 (11) ◽

pp. 4684-4693 ◽

Cited By ~ 92

Author(s):

George G. Zhanel ◽

Melanie DeCorby ◽

Heather Adam ◽

Michael R. Mulvey ◽

Melissa McCracken ◽

...

Keyword(s):

Staphylococcus Epidermidis ◽

Susceptibility Testing ◽

Multidrug Resistant ◽

Surveillance Study ◽

Bacterial Isolates ◽

Coagulase Negative Staphylococci ◽

Clinical Specimens ◽

E Coli ◽

Polymyxin E ◽

Resistance Rates

ABSTRACT A total of 5,282 bacterial isolates obtained between 1 January and 31 December 31 2008, inclusive, from patients in 10 hospitals across Canada as part of the Canadian Ward Surveillance Study (CANWARD 2008) underwent susceptibility testing. The 10 most common organisms, representing 78.8% of all clinical specimens, were as follows: Escherichia coli (21.4%), methicillin-susceptible Staphylococcus aureus (MSSA; 13.9%), Streptococcus pneumoniae (10.3%), Pseudomonas aeruginosa (7.1%), Klebsiella pneumoniae (6.0%), coagulase-negative staphylococci/Staphylococcus epidermidis (5.4%), methicillin-resistant S. aureus (MRSA; 5.1%), Haemophilus influenzae (4.1%), Enterococcus spp. (3.3%), Enterobacter cloacae (2.2%). MRSA comprised 27.0% (272/1,007) of all S. aureus isolates (genotypically, 68.8% of MRSA were health care associated [HA-MRSA] and 27.6% were community associated [CA-MRSA]). Extended-spectrum β-lactamase (ESBL)-producing E. coli occurred in 4.9% of E. coli isolates. The CTX-M type was the predominant ESBL, with CTX-M-15 the most prevalent genotype. MRSA demonstrated no resistance to ceftobiprole, daptomycin, linezolid, telavancin, tigecycline, or vancomycin (0.4% intermediate intermediate resistance). E. coli demonstrated no resistance to ertapenem, meropenem, or tigecycline. Resistance rates with P. aeruginosa were as follows: colistin (polymyxin E), 0.8%; amikacin, 3.5%; cefepime, 7.2%; gentamicin, 12.3%; fluoroquinolones, 19.0 to 24.1%; meropenem, 5.6%; piperacillin-tazobactam, 8.0%. A multidrug-resistant (MDR) phenotype occurred frequently in P. aeruginosa (5.9%) but uncommonly in E. coli (1.2%) and K. pneumoniae (0.9%). In conclusion, E. coli, S. aureus (MSSA and MRSA), P. aeruginosa, S. pneumoniae, K. pneumoniae, H. influenzae, and Enterococcus spp. are the most common isolates recovered from clinical specimens in Canadian hospitals. The prevalence of MRSA was 27.0% (of which genotypically 27.6% were CA-MRSA), while ESBL-producing E. coli occurred in 4.9% of isolates. An MDR phenotype was common in P. aeruginosa.

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AN OUTBREAK OF URINARY TRACT AND OTHER INFECTIONS DUE TO E. COLI

PEDIATRICS ◽

10.1542/peds.33.6.865 ◽

1964 ◽

Vol 33 (6) ◽

pp. 865-871

Author(s):

Avron Y. Sweet ◽

Emanuel Wolinsky

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Premature Infant ◽

Fatal Case ◽

Polymyxin B ◽

Susceptibility Pattern ◽

E Coli ◽

Stool Cultures

In a premature infant nursery 3 infants died of E. coli infections and 5 babies contracted urinary tract infection due to E. coli within a 5-month period. The causative organisms were found to be resistant to tetracycline, streptomycin, chloramphenicol, and sulfisoxazole, and sensitive to kanamycin, polymyxin B, and nitrofurantoin. From throat and stool cultures of 25 infants in the nursery, E. coli with this susceptibility pattern were recovered from 13. Of these, 9 were serotype 04:H5 and one was group 04 but nonmotile. Isolates from the urine of 3 infants with urinary tract infection and meninges of one fatal case were serotype 04:H5. Stool cultures revealed group 04 E. coli only in infants with that organism in the throat. The findings indicate that an outbreak of infections due to E. coli 04:H5 had occurred as a consequence of widespread colonization with that organism in a premature infant nursery. The unusual incidence of urinary tract infection due to a specific E. coli serotype indicates that urosepsis in the newborn can occur in epidemic form.

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Two Novel Mutations Associated with Polymyxin-B Resistance in a Pandemic Lineage of Uropathogenic Escherichia coli of the Sequence Type 69

Chemotherapy ◽

10.1159/000517817 ◽

2021 ◽

pp. 1-7

Author(s):

Carla Adriana dos Santos ◽

Rodrigo Tavanelli Hernandes ◽

Marcos Paulo Vieira Cunha ◽

Filipe Onishi Nagamori ◽

Claudia Regina Gonçalves ◽

...

Keyword(s):

Escherichia Coli ◽

Susceptibility Testing ◽

Polymyxin B ◽

Antimicrobial Treatment ◽

Sequence Type ◽

Broth Microdilution ◽

Economic Costs ◽

Novel Mutations ◽

E Coli ◽

Total Inhibition

Background: Uropathogenic Escherichia coli (UPEC) are frequent pathogens worldwide, impacting on the morbidity and economic costs associated with antimicrobial treatment. Objectives: We report two novel mutations associated with polymyxin-B resistance in an UPEC isolate collected in 2019. Methods: Isolate was submitted to antimicrobial susceptibility testing including broth microdilution for polymyxin B. Whole genome was sequenced and analyzed. Results: Polymyxin-B total inhibition occurred at 16 mg/L (resistant). UPEC isolate was assigned to the phylogroup D, serotype O117:H4, and Sequence Type 69. mcr genes were not detected, but two novel mutations in the pmrA/basS (A80S) and pmrB/basR (D149N) genes were identified. Conclusions: The occurrence of non-mcr polymyxin resistance in E. coli from extraintestinal infections underscores the need of a continuous surveillance of this evolving pathogen.

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