A prospective study on pattern of superficial surgical site infections in patients undergoing emergency laparotomy for perforation peritonitis

Abstract

Background: surgical site infections (SSIs) are recognized as a common surgical complication occurring in about 3% of all surgical procedures and in upto 20% of patients undergoing emergency intraabdominal procedures. Aims: To determine the incidence of SSIs in emergency laparotomies done for perforation peritonitis and the organisms involved and their sensitivity pattern in superficial SSI. The objective of the study was to determine the effect of planned intra operative intervention [antibiotic lavage with III generation cephalosporin e.g. ceftriaxone 1 gm and metronidazole 100 ml (5 mg per ml)] on superficial surgical site infection in emergency laparotomies done for perforation peritonitis.Methods: This prospective randomized case controlled study was carried out in P. G. Department of Surgery, S. R. N. Hospital associated with M. L. N. Medical College, Allahabad, from September 2018 to August 2019 after approval from the ethical committee and after obtaining written and informed consent either from patient or their guardian. Patients were divided into two groups viz. control group receiving the normal saline lavage and case group receiving the antibiotic lavage (III generation cephalosporins i.e., ceftriaxone (1 gm in 1000 ml NS) and metronidazole- 5 mg/ml (100 ml in 500 ml NS).Results: There is almost 50% incidence of SSI in emergency laparotomy done for perforation peritonitis. The most common organism involved in superficial SSI in present study was gut flora (E. coli) followed by normal skin colonizer (Staph. aureus).Conclusions: Intraperitoneal antibiotic lavage has a significant role in reducing the rate of SSI especially in gastroduodenal perforations.

Incidence and Predictors of Surgical Site Infection in Major Abdominal Surgeries at a Tertiary Care Center in Delhi

“…[15] −6% and Sharan et al[16] −7%. Few other Indian studies have stated higher incidence of SSI like Patel et al[17] −12.68%, Mekhla et al[5] −39%, and Singh and Yadalwar[7] −26.4%. This rise in incidence was secondary to the fact that they included emergency surgeries only[7] and rural setting[5].…”

“…Few other Indian studies have stated higher incidence of SSI like Patel et al[17] −12.68%, Mekhla et al[5] −39%, and Singh and Yadalwar[7] −26.4%. This rise in incidence was secondary to the fact that they included emergency surgeries only[7] and rural setting[5]. The previous studies have also shown lower incidence of SSI like Saravanakumar and Devi[6] −4.34%, Chada et al [4] −3.83%, and Carvalho et al [18] −3.4%, which were due to inclusion of clean or clean contaminated surgeries only [4,6].…”

“…In India, the occurrence of SSIs in elective surgeries ranged from 3.83% [4] to 39% [5]. In cases of emergency surgeries, the prevalence of SSI ranged from 12.41% [6] to 26.4% [7]. SSIs are the third commonly described nosocomial infections, accounts up to 14-16% [6].…”

Comparison of surgical site infection (SSI) between negative pressure wound therapy (NPWT) assisted delayed primary closure and conventional delayed primary closure in grossly contaminated emergency abdominal surgeries: a randomized controlled trial

“…In India, it is shown to be consistently higher, i.e., 23% to 38%, despite implementing many guidelines. SSI rates are highest in the case of abdominal surgeries when compared to other system surgeries (3), especially in emergency cases (4), with the worst being the dirty abdominal wounds (grade IV) which are reported as high up to 60% (5). Prevention of SSI is the most challenging and crucial part of patient care in the post-operative period.…”