Surgical site infections in emergency abdominal surgeries in a tertiary care hospital of North-East India

Abstract

Background: Most of the emergency abdominal surgeries are either contaminated or dirty, they carry a higher rate of complications, aided by lack of optimization of the patient before surgery as opposed to elective surgeries. Complications related to surgical site encompasses a majority and may be aggravated by pre-existing co-morbid conditions. Seroma, hematoma, wound dehiscence, surgical site infection (SSI) are some of the major complications of surgical wounds. A prospective study was carried out in Department of General Surgery, Assam Medical College and Hospital (AMCH), Dibrugarh, Assam to find out the incidence of surgical site infection (SSI), clinical presentations and causative organisms including their antibiogram.Methods: Total 280 patients undergoing emergency abdominal surgeries in Department of General Surgery, AMCH from June 2017 to May 2018 were included in the study. Preoperative, intraoperative and post-operative details were collected, recorded and analysed. In case of SSI, wound swab was taken for culture and sensitivity and antibiotics tailored accordingly. Regular follow-up for at least 30 days post-operatively was maintained.Results: The incidence of SSI was 21.43%, with male: female ratio being 1.22:1. SSI was highest in the age group above 50 years; 33.33%, and with co-morbidities. SSI seen highest in class 4 wounds (55%). Commonest clinical features were erythema, tenderness, edema around the wound in superficial SSI and deep SSI. Organ space SSI was associated with fever, trachycardia and leucocytosis. The most common isolates were Staphylococcus aereus (55%), Escherichia coli (21.67%), Pseudomonas aeruginosa (11.67%), Klebsiella species (3.3%). Conclusions: To reduce the incidence of SSI, strict adherence to antisepsis protocol specially during intraoperative and postoperative is of paramount importance in emergency surgeries.