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

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

International Surgery Journal ◽

10.18203/2349-2902.isj20181126 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1438

Author(s):

Aditya N. Patil ◽

Veerendra M. Uppin

Keyword(s):

Single Dose ◽

Surgical Site Infection ◽

Tertiary Care ◽

Surgical Site Infections ◽

Intravenous Route ◽

Antibiotic Administration ◽

Site Infection ◽

Open Appendicectomy ◽

Group A ◽

Group B

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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Intraoperative Disinfection by Pulse Irrigation with Povidone-Iodine Solution in Spine Surgery

Advances in Orthopedics ◽

10.1155/2017/7218918 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Vincenzo De Luna ◽

Federico Mancini ◽

Fernando De Maio ◽

Gabriele Bernardi ◽

Ernesto Ippolito ◽

...

Keyword(s):

Surgical Site Infection ◽

Wound Infection ◽

Spine Surgery ◽

Povidone Iodine ◽

Site Infection ◽

Iodine Solution ◽

Deep Wound ◽

Group A ◽

Group B ◽

Povidone Iodine Solution

Background. Deep wound infection in spine surgery is a debilitating complication for patients and increases costs. The objective of this prospective study was to evaluate the efficacy of wound pulse irrigation with a dilute povidone-iodine solution in the prevention of surgical site infection.Methods. 50 patients undergoing spinal surgery were randomly divided into two groups (A and B) of 25 patients each. In group A, wounds were irrigated with dilute (3%) povidone-iodine solution through a low-pressure pulsatile device. In group B, wounds were irrigated with saline solution through a bulb syringe. In both groups, specimens for bacterial culture were harvested from surgical site before and after irrigation.Results. In group A, no surgical site infection occurred; in group B, deep wound infection was observed in 3 patients. In both groups, before irrigation some cultures have been found positive for bacterial contamination.Conclusion. Our study seems to support the idea that low-pressure pulsating lavage of surgical wounds with povidone-iodine diluted to a nontoxic concentration of 3% is an effective therapeutic adjunct measure to prevent surgical site infection in spine surgery. However, the number of the enrolled patients is small and a significant statistical analysis is not practicable. This trial is registered withNCT03249363.

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Measures for Preventing Wound Infections During Elective Open Surgery for Colorectal Cancer: Scrubbing With Gauze

International Surgery ◽

10.9738/intsurg-d-13-00144.1 ◽

2014 ◽

Vol 99 (1) ◽

pp. 35-39 ◽

Cited By ~ 1

Author(s):

Takanori Goi ◽

Yuki Ueda ◽

Toshiyuki Nakazawa ◽

Katsuji Sawai ◽

Mitsuhiro Morikawa ◽

...

Keyword(s):

Colorectal Cancer ◽

Surgical Site Infection ◽

Wound Infection ◽

Infection Prevention ◽

Simple Procedure ◽

Wound Infections ◽

Site Infection ◽

Prevention Measures ◽

Group A ◽

Group B

Abstract In addition to the general surgical-site infection prevention measures in colorectal cancer surgery, we performed a simple subcutaneous scrubbing procedure with gauze at the time of abdominal closure, which reduced the incidence of wound infections. There are 289 patients whose primary colon cancer lesions were removed by elective surgeries. They were divided into Group A (74 patients with no wound infection prevention measures who were treated from 2002 to 2003), Group B (76 patients with wound infection prevention measures who were treated from 2007 to 2008), and Group C (139 patients with subcutaneous scrubbing with gauze plus the measures in Group B who were treated from 2009 to 2012). The incidence in Group A was 23%, while the corresponding values in Group B and Group C were 14.5% and 2.9%, respectively. The incidence of wound infections was substantially reduced by additional subcutaneous scrubbing with a saline solution and gauze during closure of a surgical incision. This very simple procedure was considered useful for surgical site infection prevention.

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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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Comparative study of linear closure technique versur purse string closure technique of skin closure in stoma reversal.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.05.4184 ◽

2020 ◽

Vol 27 (05) ◽

pp. 1038-1042

Author(s):

M. Rehman Gulzar ◽

Faiqa Aslam ◽

Muhammad Umar Farooq ◽

Shahbaz Ahmad ◽

Sabeen Adil ◽

...

Keyword(s):

Wound Healing ◽

Comparative Study ◽

Surgical Site Infection ◽

P Value ◽

Site Infection ◽

Closure Technique ◽

Purse String ◽

Group A ◽

Group B ◽

Wound Length

Objectives: To compare the results of linear closure technique with purse string closure technique in terms of surgical site infection, wound healing (scar cosmesis) and wound length. Study Design: Comparative Study. Setting: Surgical Unit V, Faisalabad Medical University, Faisalabad. Period: January 2016 to January 2019. Material & Methods: A total of 100 patients were operated in our unit during the study period & were allocated into two groups randomly: Group A (Linear closure) Group B (Purse string closure) included 50 patients in each group. The primary outcome measures were, surgical site infection, wound healing (scar cosmesis) and wound length. Results: During follow up period Surgical site infection was noted in 17 patients out of 100 with 14 patients in Group A and 03 Patients in Group B (p value 0.002). Regarding wound healing 60% patients were having good scar and 20% patients were having satisfactory and 20% having poor scar in Group A. while in Group B 82% patients were having good scar and 18% patients were having satisfactory scar (p value 0.00). Mean wound length in Group A was 5.14 with SD 1.2978 while in Group B mean length was 3.8 with SD 1.3095. Conclusion: Our study concludes that purse string closure is superior to linear closure technique in terms of surgical site infection, wound healing (scar cosmesis) and wound length.

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Comparing SSI In Purse-String Versus Conventional Primary Closure Following Stoma Reversal

Esculapio ◽

10.51273/esc21.251713 ◽

2021 ◽

Vol 17 (1) ◽

pp. 15-19

Author(s):

Sabih Nofal ◽

Anum Arif ◽

Ahsan Khan ◽

Sundus Saif ◽

Abdul Waheed Khan ◽

...

Keyword(s):

Surgical Site Infection ◽

Hospital Stay ◽

Primary Closure ◽

Length Of Hospital Stay ◽

P Value ◽

Site Infection ◽

Purse String ◽

Stoma Reversal ◽

Group A ◽

Group B

Objective: To compare the frequency of Surgical Site Infection ( SSI ) and mean length of hospital stay between the Purse-string closure and conventional primary closure techniques for stoma reversal. Methods: The study was carried out in Surgical Unit-III, Lahore General Hospital Lahore from January 5, 2018 to July 5, 2018. The study designed as a Observational Study. Patients undergoing surgery for Ileostomy were randomly divided into two groups, Group-A (Purse-string closure) and Group-B (Conventional primary closure). All the patients were called for follow up checkup on 14th days after operation and after one month. Both of the groups were checked and recorded for SSI after operation and hospital stay. The data was statistically analyzed by using SPSS v23.0.t test (independent sample) used for the comparison of hospital stay mean. Chi-square was also used for the comparison of the frequencies of SSI. Data were stratified for gender and age. A p-value ≤0.05 was considered as significant. Results: A total of 140 patients were enrolled for this study. Patients were divided into two groups i.e. Group- A (Purse-string closure) and Group-B (Conventional primary closure). In group-A, mean duration of hospital stay was 5.7±1.0 days, while 7.3±1.1 days in group-B, which is statistically significant with a p-value of 0.000. In group-A, surgical site infection was in 4(5.7%) patients, while 11(15.7%) patients of group-B, which is statistically significant with a p-value of 0.046. Conclusion: The frequency of surgical site infection and mean length of hospital stay after stoma reversal, purse-string suturing technique is significantly less than conventional primary closure technique. Key Words: Surgical stoma; Ileostomy; Closure; Infection. How to cite: Nofal S., Arif A., Khan A., Saif. S., Khan W.A., Arif A. Comparing SSI in Purse-String Versus Conventional Primary Closure Following Stoma Reversal. Esculapio 2021; 17(01): 15-19

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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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Post-operative surgical site infection among general surgery patients: Rate and risk factors.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.09.6076 ◽

2021 ◽

Vol 28 (09) ◽

pp. 1276-1281

Author(s):

Shahid Nazir Memon ◽

Shehzada Ameer Ahmed Babar ◽

Sarwat Sultana ◽

Sulhera Khan ◽

Amir Hussain Khan ◽

...

Keyword(s):

Surgical Site Infection ◽

Wound Infection ◽

General Surgery ◽

Surgical Site Infections ◽

High Rate ◽

P Value ◽

Emergency Setting ◽

Site Infection ◽

Emergency Case ◽

Cross Sectional

Objectives: High rate of post-surgical infections are reported with scanty effort for controlling them. The objectives were to evaluate frequency of surgical site infections in patients undergoing general surgery. Study Design: Cross Sectional Observational Study. Setting: Naz Memorial Hospital. Period: March 2019 to March 2020. Material & Methods: This study was conducted in general surgery ward for 1 year. All patients over 18 years admitted in surgery ward either as elective or emergency case were included while patients having any wound infection, operated in other hospital or diabetic foot and all those operated for incision and drainage of abscess were excluded. All patients that were operated during the study period were followed for any wound infection development till one qAqmonth. SPSS was used for data entry and analysis keeping p-value of <0.05 as significant. Results: 75 from 200 patients developed surgical site infection, 46 (61.3%) were operated in emergency. Among 24 contaminated surgeries type, 70.8% were reported having SSI (p-0.05) while from 28 dirty types of surgeries 78.6% of patients had a SSI (p-0.03). 25% were anemic, 21% diabetic while (20%) were reported to be hypertensive, 13 (17%) gave positive history of smoking while 12 (16%) were obese. Conclusion: Higher proportion of surgical site infection was observed in patients undergoing contaminated and dirty type of surgeries. Most patients with SSI were operated in emergency setting and anemia and diabetes were the most common risk factor reported in the infected patients.

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465 No Role for Postoperative Antibiotics in Uncomplicated Appendicitis

British Journal of Surgery ◽

10.1093/bjs/znab134.283 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

N Ayoub ◽

Y Tryliskyy ◽

M K Baig

Keyword(s):

Wound Infection ◽

P Value ◽

Nice Guidelines ◽

Uncomplicated Appendicitis ◽

Perforated Appendix ◽

Group A ◽

Preoperative Antibiotics ◽

Group B ◽

Variable Practice

Abstract Introduction Several studies have shown benefit from use of preoperative antibiotics in reducing postoperative infection after appendectomy as well as efficacy of postoperative antibiotics in complicated appendicitis (defined as perforated appendix or presence of pus in peritoneum). While for uncomplicated appendicitis, several studies showed no benefit from antibiotics postoperatively but there are no clear NICE guidelines till now and so surgeons have different practice based on their preferences. Method This study included patients who had appendectomy for uncomplicated appendicitis in Worthing hospital from 1st July 2019 till 30th June 2020. The end point was 30-day follow up postoperatively for wound infection or collection. Results 90 patients were admitted with uncomplicated appendicitis with age 6-80 years (mean of 31.3). 46 patients (51%) did not receive postoperative antibiotics (group A) and 44 (49%) received postoperative antibiotics (group B) with a variable practice from one dose to 8-day course. postoperatively, only 1 patient (2.1%) in group A developed wound infection requiring drainage while none in group B developed complications (p-value=1). Conclusions Administration of postoperative antibiotics in uncomplicated appendicitis showed no superiority over non-administration. in addition, they add extra cost on NHS. So, their routine use postoperatively is not recommended, however, larger studies are required to confirm this.

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