Incidence, Risk Factors, Microbiological Profile, and Clinical Outcomes of Surgical Site Infections Following General Surgical Procedures: A Prospective Cohort Study.

Dr. Vaddadhi Sindhuri; Krishna

doi:10.51168/2s9spm35

Autori

Dr. Vaddadhi Sindhuri Assistant Professor, Department of General Surgery, Maharajah's Institute of Medical Science, Vizianagaram, Andhra Pradesh, India
Krishna Assistant Professor, Department of General Surgery, Maharajah's Institute of Medical Science, Vizianagaram, Andhra Pradesh, India

DOI:

https://doi.org/10.51168/2s9spm35

Cuvinte cheie:

Emergency Surgery, General Surgery, Microbiology, Risk Factors, Surgical Site Infection, Wound Infection

Rezumat

Background:

Surgical site infections (SSIs) remain an important cause of postoperative morbidity, prolonged hospitalization, repeated intervention, and antimicrobial use, particularly after emergency and contaminated operations.

Objectives:

To determine the 30-day cumulative incidence and pattern of SSI following general surgical procedures and to evaluate associated risk factors, microbiological profile, and short-term clinical outcomes.

Methods:

This prospective cohort study included 80 adults undergoing elective or emergency general surgical procedures at Maharajah's Institute of Medical Sciences, Nellimarla, Vizianagaram, Andhra Pradesh, India, from February 2025 to January 2026. Participants were followed for 30 postoperative days. SSI was classified as superficial incisional, deep incisional, or organ/space infection. Categorical variables were compared using the chi-square and Fisher's exact tests, while continuous variables were assessed using the independent-samples t test and Mann–Whitney U test, as appropriate. Unadjusted odds ratios with 95% confidence intervals were calculated, with p<0.05 considered statistically significant.

Results:

Fourteen of 80 participants developed SSI, giving a 30-day cumulative incidence of 17.5%. Superficial incisional SSI was most frequent (57.1%). SSI occurred more often after emergency surgery (31.3% vs 8.3%; p=0.014), operations lasting >120 minutes (33.3%; p=0.024), and contaminated/dirty procedures (40.0%; p=0.005). Thirteen infections were culture-positive, yielding 15 isolates; 66.7% were Gram-negative. Escherichia coli and Staphylococcus aureus were the leading isolates. SSI was associated with longer hospitalization, wound dehiscence, and higher 30-day readmission.

Conclusion:

The 30-day cumulative incidence of SSI was substantial and was concentrated among emergency, prolonged, and contaminated or dirty procedures. Culture-directed treatment and targeted perioperative prevention are important to reduce postoperative morbidity.

Recommendations:

Risk-stratified surveillance, appropriate antimicrobial prophylaxis, glycaemic optimization, and local antibiogram-guided management should be strengthened, particularly for high-risk procedures.

Biografii autori

Dr. Vaddadhi Sindhuri, Assistant Professor, Department of General Surgery, Maharajah's Institute of Medical Science, Vizianagaram, Andhra Pradesh, India

is an Assistant Professor in the Department of General Surgery, Maharajah's Institute of Medical Science, Vizianagaram, Andhra Pradesh, India. Her academic interests include general surgical practice, postoperative outcomes, surgical-site infection prevention, and perioperative quality improvement.
Krishna, Assistant Professor, Department of General Surgery, Maharajah's Institute of Medical Science, Vizianagaram, Andhra Pradesh, India

is an Assistant Professor in the Department of General Surgery, Maharajah's Institute of Medical Science, Vizianagaram, Andhra Pradesh, India. His academic interests include general surgery, postoperative complications, clinical outcomes research, and infection prevention.

Referințe

1. World Health Organization. Global guidelines for the prevention of surgical site infection. 2nd ed. Geneva: World Health Organization; 2018. PMID: 30689333.

2. Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784-791. https://doi.org/10.1001/jamasurg.2017.0904

3. Allegranzi B, Bischoff P, de Jonge S, Kubilay NZ, Zayed B, Gomes SM, et al. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016;16(12):e276-e287. https://doi.org/10.1016/S1473-3099(16)30398-X

4. Allegranzi B, Zayed B, Bischoff P, Kubilay NZ, de Jonge S, de Vries F, et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016;16(12):e288-e303. https://doi.org/10.1016/S1473-3099(16)30402-9

5. GlobalSurg Collaborative. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. Lancet Infect Dis. 2018;18(5):516-525. https://doi.org/10.1016/S1473-3099(18)30101-4

6. NIHR Global Research Health Unit on Global Surgery. Reducing surgical site infections in low-income and middle-income countries (FALCON): a pragmatic, multicentre, stratified, randomised controlled trial. Lancet. 2021;398(10312):1687-1699. https://doi.org/10.1016/S0140-6736(21)01548-8

7. Jatoliya H, Pipal RK, Pipal DK, Biswas P, Pipal VR, Yadav S, et al. Surgical site infections in elective and emergency abdominal surgeries: a prospective observational study about incidence, risk factors, pathogens, and antibiotic sensitivity at a government tertiary care teaching hospital in India. Cureus. 2023;15(10):e48071. https://doi.org/10.7759/cureus.48071

8. Meena R, Chakravarti S, Agarwal S, Jain A, Singh S, Dey S. A prospective study of surgical site infection with its risk factors and their correlation with the NNIS risk index. J West Afr Coll Surg. 2023;13(4):26-33. https://doi.org/10.4103/jwas.jwas_6_23

9. Huda F, Shasheendran S, Basu S, Kumar N, Rajput D, Singh SK, et al. Risk factors of surgical site infection in elective laparotomy in a tertiary care center: an observational study. Int J Burns Trauma. 2022;12(3):106-113.

10. Alkaaki A, Al-Radi OO, Khoja A, Alnawawi A, Alnawawi A, Maghrabi A, et al. Surgical site infection following abdominal surgery: a prospective cohort study. Can J Surg. 2019;62(2):111-117. https://doi.org/10.1503/cjs.004818

11. Aga E, Keinan-Boker L, Eithan A, Mais T, Rabinovich A, Nassar F. Surgical site infections after abdominal surgery: incidence and risk factors. A prospective cohort study. Infect Dis (Lond). 2015;47(11):761-767. https://doi.org/10.3109/23744235.2015.1055587

12. Lindsjö C, Sharma M, Mahadik VK, Sharma S, Stålsby Lundborg C, Pathak A. Surgical site infections, occurrence, and risk factors, before and after an alcohol-based handrub intervention in a general surgical department in a rural hospital in Ujjain, India. Am J Infect Control. 2015;43(11):1184-1189. https://doi.org/10.1016/j.ajic.2015.06.010

13. Shah S, Singhal T, Naik R. A 4-year prospective study to determine the incidence and microbial etiology of surgical site infections at a private tertiary care hospital in Mumbai, India. Am J Infect Control. 2015;43(1):59-62. https://doi.org/10.1016/j.ajic.2014.10.002

14. Amirah A, Harahap J, Willim HA, Suroyo RB, Henderson AH. Effect of comorbidities on the incidence of surgical site infection in patients undergoing emergency surgery: a systematic review and meta-analysis. J Clin Med Res. 2024;16(7-8):345-354. https://doi.org/10.14740/jocmr5222