Intra-incisional versus intravenous route of antibiotic administration in preventing surgical site infections: a randomized controlled trial

Background: Surgical site infection (SSI) is one of the most common postoperative complications following abdominal surgeries. Whilst the use of prophylactic antibiotics has been shown to reduce postoperative wound infection, controversy still remains as to the optimum route of administration and the duration of treatment. This study aims to compare the efficacy of a preoperative single dose of a cephalosporin antibiotic (cefotaxime) administered intraincisionally versus that administered intravenously, in preventing postoperative surgical site infections following appendicectomy.Methods: Sixty consecutive cases diagnosed as uncomplicated appendicitis who consented for open appendicectomy at a tertiary care institute were included in the study. Cases were randomized to 2 comparable groups of 30 patients each. Preoperatively, patients in Group A received a single dose of Inj. Cefotaxime 1g intraincisionally while those in Group B received the same intravenously. Incision sites were examined every alternative day starting on postoperative day 3 until removal of sutures. Signs of surgical site infection, if any, were recorded and outcomes were statistically tested for significance.Results: One patient in Group A (3.3%) and 4 patients in Group B (13.3%) showed signs of postoperative surgical site infection (p >0.05) during the follow up period which prolonged their hospital stay.Conclusions: This study showed that a single dose preoperative intraincisional administration of cefotaxime was as effective as intravenous administration for prevention of postoperative surgical site infection after open appendicectomy. Although the difference was not statistically significant, there was a reduced incidence of SSI in individuals who received intraincisional antibiotic. These results are encouraging for a way forward in reducing unnecessary burdening of systemic antibiotics in patients undergoing abdominal surgeries.

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Surgical Site Infections in Abdominal Surgeries - A Clinicopathological Prospective Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/14 ◽

2021 ◽

Vol 8 (02) ◽

pp. 69-74

Author(s):

Biswaranjan Mohapatra ◽

Dipesh Kumar Padhihari ◽

Mrutynjay Das ◽

Sai Barath Sunkara ◽

Saikh Kasif Sahajada

Keyword(s):

Prospective Study ◽

Surgical Site Infection ◽

Medical Science ◽

Operating Time ◽

Surgical Techniques ◽

Surgical Site Infections ◽

Purulent Discharge ◽

Site Infection ◽

Group A ◽

Group B

BACKGROUND Surgical site infection still remains a nightmare for most surgeons even in these times despite many advances in medical science, surgical techniques & better operating room environment. Surgical site infection (SSI) is defined as ‘an infection occurring within 30 days of a surgery (or within 1 year if an implant is left in place after procedure) and affecting either incision or deep tissues at the operation site. METHODS A single observer, cross sectional, prospective study was carried out in the Dept. of General Surgery, in collaboration with Microbiology & Pathology Departments of Hi-tech Medical College and Hospital, Bhubaneswar, Odisha. The study included all patients who underwent laparotomy during the period of study, patients of all age groups except neonates and patients with post-operative surgical site infections. RESULTS The prospective study involved culture and sensitivity of 114 patients undergoing clean-contaminated surgeries (group A), contaminated-surgeries (group B) in the Department of Surgery at our institute. The study shows that the maximum number of cases were between 21 to 60 yrs. of age. (78 %) and the mean age in the group A was 39.2 years while in group B, it was 39.8 years. There was a total of 90 patients between 21 - 60 yrs. of age. Mean hospital stay in group A was 5.7 days and group B was 8.9 days. The sex ratio is quite evenly matched, 63 male patients and 51 female patients out of 114 cases. Amongst the 114 subjects, group A comprised of 58.77 % (67) while group B consisted of 41.22 % (47.13) patients. Out of 67, 13 from group A came back as sterile, in group B sterile samples were 10. CONCLUSIONS This study concludes that age, sex, class of wound, peri-operative management, operating time and co-morbidities of the patient, all have a significant effect on the incidence of surgical site infections. KEYWORDS Surgical Site Infection, Laparotomy, Purulent Discharge, Drain

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Comparative study of single dose preoperative antibiotic versus five days antibiotic course in preventing surgical site infection for pediatric inguinal herniotomy

IP International Journal of Medical Paediatrics and Oncology ◽

10.18231/j.ijmpo.2021.027 ◽

2021 ◽

Vol 7 (3) ◽

pp. 134-139

Author(s):

Pinaki Ranjan Debnath ◽

Arnab Kumar Saha ◽

Rashmi D ◽

Vasu Gautam ◽

Chetna Khanna ◽

...

Keyword(s):

Single Dose ◽

Surgical Site Infection ◽

Wound Care ◽

Oral Antibiotic ◽

Site Infection ◽

Significant Difference ◽

Group A ◽

Group B ◽

Inguinal Herniotomy

To compare single dose preoperative antibiotic versus five days antibiotic course in preventing surgical site infection for the pediatric inguinal herniotomy.The present study was conducted on 100 patients of elective inguinal herniotomy from January 2019 to April 2020 and compared on the basis of single dose preoperative antibiotic versus five days antibiotic course. All the patients were evaluated on the 3rd, 7th and 28th post-operative period and instructions were given to the guardians about wound care and to attend for early follow up if any signs & symptoms of wound infection appear.50% of the patients were treated with prophylactic single dose antibiotic, i.e. inj. Ceftriaxone (30 mg/kg/dose) at the time of induction only and rest 50% were treated with inj. Ceftriaxone(30mg/kg/dose) at the time of induction as well as postoperatively at night followed by four days of oral antibiotic with Syr/Tablet. Cephalexin (25mg/kg/day) three times daily for another 4 days.Surgical Site Infection (SSI) in Group-B (4.0%) was higher than that of Group-A (2.0%) on day 3 but it was not significant (p=0.40). There was no significant difference in health status of the patients of the two groups when compared on post-operative day 7 and day 28 (p=0.99, p=0.99 respectively).Implementation of single dose antibiotic prophylaxis regimes tailored to the prevalent organisms in the institution can result in enormous savings, as the study shows significant reduction in hospital stay with no significant increase in incidence of SSI.

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Superficial surgical site infections following stone and non-stone bile duct surgery- A comparative analysis

Northern International Medical College Journal ◽

10.3329/nimcj.v11i2.54061 ◽

2021 ◽

Vol 11 (2) ◽

pp. 458-462

Author(s):

Chishti Tanhar Bakth Choudhury ◽

BH Nazma Yasmeen ◽

Manir Hossain Khan ◽

AHM Towhidul Alam ◽

Shirin Akhter

Keyword(s):

Bile Duct ◽

Surgical Site Infection ◽

Wound Infection ◽

Surgical Site Infections ◽

Stone Disease ◽

P Value ◽

Site Infection ◽

Causative Agents ◽

Group A ◽

Group B

Background : Superficial surgical site infection (SSSI) is a vital issue after biliary surgery. Surgical site infections remain a major cause of illness in the post-operative period. Objectives : The purpose of the present study was to compare the number of wound infection and the causative organism of surgical site infection of patient of stone and non-stone bile duct surgery. Methodology : This cross-sectional study was carried out in the Department of Surgery at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from May 2017 to April 2018 for a period of 12 months. Patients presented with biliary disease of stone and non-stone variety were selected as study population. Patients were divided into 2 groups designated as group A and group B. Patients with the biliary stone disease were enrolled in group A and the biliary nonstone disease patients were in the group B. Patients were followed up in the postoperative period up to 2 weeks to find out the incidence of wound infection and its risk factors, causative agents, and some other variables. Certain variables were closely monitored to find the postoperative outcome as these variables were standard parameters in assessment of the outcome of the study. Results : A total number of 50 patients were recruited for this study of which 25 patients were enrolled in group A and the 25 patients were enrolled in group B. Mean age was 42.48 ± 17.21 years in group A and 40.04 ± 21.37 years in group B. The difference was not statistically significant ( p=0.659). Males were predominant in both groups. Male female ratio was 1.77:1 and 1.08:1 in group A and group B respectively. Inflammatory evidence of gall bladder with pericholecystic collection was found in 5 (20%) and 6 (24%) patients in group A and group B. There was evidence of cholangitis in 8 (32%) and 4 (16%) patients in group A and group B respectively. Evidence of inflammation at the wound site, was found in 14 (56%) patients in group A and 7 (28%) patients in group B. There was statistically significant difference between these 2 groups in the incidence of superficial surgical site infection, ( p value is 0.045). Regarding per operative collected bile, we found E. Coli in 4 cases in group A and 3 cases in group B ( p value is 0.408). Klebsiella spp. was found in 1 patient in group A. Wound swab C/S identified E. Coli in 1 patient in group A. Staph aureus was found in 1 and 2 patients in group A and group B respectively ( p value is nonsignificant). Conclusion : In conclusion, there is a difference in the incidence of occurrence of surgical site infection and causative agents after stone and non-stone bile duct surgery. Stone disease has increased chance of wound infection than nonstone disease of bile ducts. Northern International Medical College Journal Vol.11 (2) Jan 2020: 458-462

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ASSESSMENT OF TWO OR MORE ANTIBIOTICS REGIMEN VERSUS ONE OR NO ANTIBIOTIC REGIMEN IN POST-OPERATIVE SURGERY

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2017v9i11.21570 ◽

2017 ◽

Vol 9 (10) ◽

pp. 188

Author(s):

Mihirkumar B. ◽

Ashley S. ◽

Nawaz S. ◽

Surekha G. ◽

Padmaa M. Paarakh

Keyword(s):

Surgical Site Infection ◽

Surgical Site Infections ◽

Site Infection ◽

Antibiotic Regimen ◽

Female Patients ◽

Operative Surgery ◽

Group A ◽

Group B ◽

Surgery Department ◽

Hospital Acquired

Objective: Surgical site infections [SSI] are the leading cause of hospital-acquired infections. The objective of this study was to evaluate whether surgical site infections can be reduced with two or more antibiotics regimen versus one or no antibiotic regimen in post-operative surgery.Methods: The patients were grouped into 2 groups. Group A (two or more antibiotics regimen) and Group B (one or no antibiotic regimen). Then the patients were followed on 1st, 2nd, 3rd and 4th week respectively after surgery to check for any surgical site infection by direct interviewing the patients. Results: The overall surgical site infection rate was 48.3 % (58 out of 120 patients). However, this study was more dominated by female patients–there were 63% female patients compared to 37 % male patients enrolled in this study. Also, the post-operative surgical site infection was comparatively observed more in female patients than in male. General surgery department too had many gynaecology related patients followed by Orthopaedic and Endocrinology surgeries. Results revealed that the patients in Group A (Two or more antibiotics) had significantly lower number of surgical site infections when compared with Group B (One or no antibiotics) with p<0.001.Conclusion: Our study concludes that patients receiving two or more antibiotics had significantly less number of post-operative surgical site infections when compared to patients receiving one or no antibiotics and following two or more antibiotics can reduce the excess hospital cost.

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Prophylactic Antibiotics in Elective Laparoscopic Cholecystectomy is it Necessary?

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v16i2.24866 ◽

2018 ◽

Vol 16 (2) ◽

pp. 16-18

Author(s):

Anup Sharma ◽

Arun Shah

Keyword(s):

Laparoscopic Cholecystectomy ◽

Single Dose ◽

Surgical Site Infection ◽

Prophylactic Antibiotic ◽

Prophylactic Antibiotics ◽

Site Infection ◽

Medical College ◽

Group A ◽

Elective Laparoscopic Cholecystectomy ◽

Group B

Background: Elective laparoscopic cholecystectomy (LC) has a low risk for Surgical Site Infection (SSI). In spite many surgeons still use prophylactic antibiotics. The aim of this study was to find out the need of prophylactic antibiotics in elective LC. Method: This study was carried out from 2017 June to 2018 August in the Department of Surgery Nepalgunj Medical College and Teaching Hospital Kohalpur (NGMC). Patients were placed into two groups. Group A received a single dose of prophylactic antibiotic and group B patients did not receive any prophylactic antibiotic. In both groups the SSI were recorded and compared. Results: Overall SSI was 5(3.33%) among 150. In group A 2 (2.66%) patients had SSI and in group B 3 (4%) had SSI. Using or not using prophylactic antibiotics did not correlate with SSI (p= .154). Conclusions: Prophylactic antibiotic is not recommended in elective LC. Prophylactic antibiotic does not reduce the rate of SSI.

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A study of surgical site infections with and without the use of pre-operative antibiotics

International Surgery Journal ◽

10.18203/2349-2902.isj20194180 ◽

2019 ◽

Vol 6 (10) ◽

pp. 3806

Author(s):

Arun Kumar Gupta ◽

Seema Mittal ◽

Tejinder Singh Dall ◽

Darpan Bansal

Keyword(s):

Surgical Site Infection ◽

Surgical Site Infections ◽

Site Infection ◽

Medical Sciences ◽

Gram Positive ◽

Gram Negative ◽

Gram Positive Bacteria ◽

Group A ◽

Group B ◽

Clean Contaminated

Background: In spite of advances in infection control, infection still remains the major limitor of surgical horizons. After urinary tract infection, surgical site infection is a main factor contributing to morbidity and mortality.Methods: The present study was carried out in the department of General Surgery and Microbiology at Shri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Sri Amritsar. In this study 100 patients were selected undergoing clean or clean contaminated surgeries out of which 50 patients were not given pre-operative antibiotics (first group) and remaining 50 patients (second group) were given preoperative antibiotics.Results: Sample consisted of 100 patients with mean age of patients was 36.97 years. Total number of males was 57 and females were 43. 25 (50%) of patients who had not received prophylaxis developed SSI (group A) and 28 (56%) patients who received prophylaxis developed SSI (group B). Most common bacteria isolated from SSI was Staphylococcus aureus for both the groups. 10 (52.63%) Gram positive bacteria were isolated from microscopic examination of infected sample (A) and 25 (73.52%) were gram negative bacteria. 25 (73.52%) were Gram positive bacteria in group (b) and 9 (26.47%) were Gram negative isolates.Conclusions: It can be concluded from the present study that there is no need to give antibiotic prophylaxis prior to surgery in order to reduce the incidence of surgical site infection.

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Comparison of single dose versus multiple doses of antibiotic prophylaxis for prevention of surgical site infection

International Surgery Journal ◽

10.18203/2349-2902.isj20215144 ◽

2021 ◽

Vol 9 (1) ◽

pp. 129

Author(s):

Swapan Das ◽

Rajib Kundu ◽

Bani Prasad Chattopadhyay

Keyword(s):

Single Dose ◽

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Multiple Dose ◽

Cost Effective ◽

Site Infection ◽

Significant Difference ◽

Group A ◽

Group B ◽

Clean Contaminated

Background: Surgical site infection is a common problem following general surgical procedures. Despite major improvement in antibiotics, improved antiseptic measures SSI continues to present a big challenge. In this study we will compare single dose versus multiple dose antibiotic prophylaxis for prevention of SSI in clean and clean contaminated surgical wound.Methods: This is an institution based prospective, comparative study, with total 60 patients as study population. Clinical finding, wound swab culture and routine haematological reports were taken as study variables. Patients receiving single dose antibiotic and multiple dose antibiotic were included in ‘Group A’ and ‘Group B’ respectively. The surgical sites were examined from post-operative days 3 to 8 for signs of infection.Results: In This study, 46.7% patients were female, and 53.3% patients were male. In Group-A, patients having post operative fever, tachycardia and leucocytosis were 16.7%, 13.3% and 20.0% respectively. 6.7% patients had purulent and 10.0% patients had seropurulent discharge from wound. In Group-B, patients having post operative fever, tachycardia, and leucocytosis were 13.3%, 16.7% and 13.3% respectively. 6.7% patients had purulent and seropurulent discharge from wound. There is no statistically significant difference between two groups regarding post operative fever, tachycardia, leucocytosis and wound discharge.Conclusions: There is no significant difference between single dose and multiple dose antibiotic prophylaxis to prevent SSI in patients for elective clean and clean contaminated surgery however single dose is more cost effective.

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To study the effectiveness of prophylactic use of ceftriaxone (single dose) in caesarean section in low risk patients in a tertiary care center, Moradabad, India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20175440 ◽

2017 ◽

Vol 5 (12) ◽

pp. 5278

Author(s):

Ruby Kumari ◽

Arti Sharma ◽

. Sheetal ◽

Pratibha Roy ◽

. Anupriya

Keyword(s):

Single Dose ◽

Caesarean Section ◽

Surgical Site Infection ◽

Care Center ◽

Tertiary Care ◽

Infectious Complications ◽

Low Risk ◽

Tertiary Care Center ◽

Site Infection ◽

Risk Patients

Background: There is increasing incidence of caesarean section throughout the world. As caesarean section is associated with infectious complications which increase the rate of morbidity and mortality of mothers. For prevention of infectious complications antibiotics are used but careless use of antibiotics increasing incidence of antibiotic resistance. Many guidelines and studies recommend single dose antibiotic prophylaxis for women undergoing elective or non-elective caesarean section. The aim of this study was to assess the effectiveness of Ceftriaxone as prophylactic antibiotic (single dose) in caesarean section in low risk patients.Methods: A Prospective single blind study was carried out in the department of obstetrics and gynaecology, TMMC and RC Moradabad, a tertiary care center, in all low risk patients underwent for Elective and Emergency Lower segment caesarean section for 1 year from 1st June 2015 to May 2016 on 110 patients. Data was collected and analyzed by percentage and proportion.Results: Prevalence of caesarean section was maximum in women of 26-35years age group (52.72%),about 67.27% was emergency LSCS, most common indication of caesarean section was Fetal distress (29.09%),refusal for vaginal delivery after caesarean section (10.90%) was one of the cause for increasing rate of repeat caesarean section, 41.81% women in labour,72.27% cases were with intact membrane, in 9.09% cases, antibiotic had to change in post-operative period due to urinary tract infection and surgical site infection, most common post-operative complication was superficial surgical site infection with purulent discharge (2.72%). No major life-threatening complication occurred.Conclusions: Single dose of Ceftriaxone is effective for prevention of post-caesarean infectious complication.

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Abdominal Wound Closure in Gynaecological or Obstetrical Surgery with Vicryl® (Polyglactin910) Versus Vicryl Plus® (Polyglactin910 with Triclosan Added): A Comparative Study

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v17i1.25307 ◽

2019 ◽

Vol 17 (1) ◽

pp. 10-12

Author(s):

Binod Kumar Mahaseth

Keyword(s):

Surgical Site Infection ◽

Surgical Complication ◽

College Teaching ◽

Controlled Study ◽

Skin Closure ◽

Site Infection ◽

Comparative Efficacy ◽

Group A ◽

Group B ◽

Johnson Company

Background: Surgical site infection is the most common post-surgical complication in surgical patients. The incidence of surgical site infection varies from 3-20% (or even more) in different part of the world. To date, the best method and material for skin closure has not been recommended by anybody. Triclosan is an antiseptic agent used for coating a suture material to prevent the infections. This case-controlled study was carried out to determine the comparative efficacy of sutures; Objective: This case-controlled study was carried out to determine the comparative efficacy of sutures: vicryl® and vicryl plus® (triclosan, an antiseptic incorporated with suture), in reducing surgical site infection in laparotomy for clean Gyn/Obs operations. Material and method: This case-controlled study was carried out in Dept. Of Gynae/Obs at Nepalgunj Medical College Teaching Hospital, Kohalpur. The period of the study was from Jan 2018 to January 2019. A total of 50 participants were enrolled in the study, who met the inclusion criteria. The patients were divided into two groups A and B, each consisting of 25 patients. The patients were allocated in the groups alternately to remove bias. The Group A consisted of patients where Vicrylplus® (Ethicon, Johnson & Johnson Company, Ahmadabad, India) polyglactin910 with triclosan) was used and Group B consisted of patients where vicryl ® (Ethicon, Johnson & Johnson Company, Ahmadabad, India) polyglactin910 alone) was used. Patients whose abdominal wounds were found infected, pus swab for culture were taken and sent for aerobic culture and sensitivity. All patients received ceftriaxone and metronidazole single dose before operations prophylactically. Result: Surgical site infection ingroup A was 3 cases out of 25 (12%) and in group B it was 6 cases out of 25(24%). Triclosan added polyglactin910 suture found to be statistically non significant concerning prevention of SSI as compared to polyglactin910 (p=0.472). The mean age of the study population was in group A was (29.76±7.47) and in group B was (27.12±7.42).

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Prophylactic use of antibiotics as per SIGN 104 guidelines versus routine antibiotic prophylaxis for prevention of surgical site infection in clean and clean contaminated ENT surgical procedures: a comparative study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195698 ◽

2019 ◽

Vol 6 (1) ◽

pp. 106

Author(s):

M. Bharath ◽

J. R. Galagali ◽

Awadhesh Kumar Mishra ◽

Ajay Mallick ◽

E. Nikhilesh

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Surgical Procedures ◽

Antibiotic Use ◽

Site Infection ◽

Significant Difference ◽

Group A ◽

Prophylactic Use ◽

Group B ◽

Clean Contaminated

Background: Many clinicians continue to use antibiotic prophylaxis routinely in all surgical procedures, ignoring the guidelines issued by policy makers. In this prospective study we compared the rate of surgical site infection (SSI) in patients who received prophylactic antibiotics as a routine; with the rate of SSI in patients getting antibiotics strictly as per SIGN 104 Guidelines, for clean and clean contaminated procedures.Methods: The study population comprised 235 patients. Group A consisted of 119 patients having 77 (65%) males and 42 (35%) females while Group B had 116 patients - 71 (61%) males and 45 (39%) females. Group A received routine antibiotic prophylaxis in all cases, while Group B received antibiotic prophylaxis as per SIGN 104 guidelines only. Both the groups were followed up for one month post-operatively for SSI and complications.Results: SSI occurred in 2 patients (1.68%) in Group A and in 3 (2.59%) patients in Group B. There was no significant difference in the rate of SSI between the two groups (p=0.68). Procedure wise maximum SSI occurred in tympanoplasty and laryngectomy. Due to infection one case of tympanoplasty had graft failure and one case of laryngectomy had delayed wound healing. No major complications related to infection or antibiotic use occurred in either group.Conclusions: Selective use of antibiotic prophylaxis as per SIGN 104 Guidelines does not lead to increase in SSI in clean and clean contaminated ENT procedures.

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