Risk Factors And Prevention Strategies For Surgical Site Infections In Emergency Abdominal Surgery
DOI:
https://doi.org/10.63682/jns.v14i32S.8402Keywords:
Surgical site infection, emergency abdominal surgery, risk factors, prevention strategies, antimicrobial resistanceAbstract
Background: Surgical site infections (SSIs) represent a significant burden in emergency abdominal surgery, with incidence rates substantially higher than in elective procedures. This study aimed to determine the incidence of SSIs following emergency abdominal surgery, identify modifiable risk factors, and evaluate the effectiveness of current prevention strategies in our institutional setting.
Methods: This prospective observational cohort study was conducted from January 2023 to June 2024 at KAHER's JGMM Medical College, Hubballi. Adult patients (≥18 years) undergoing emergency abdominal surgery within 24 hours of admission were included. Patients were monitored for SSI development using CDC criteria during hospitalization and at follow-up visits (1 week, 2 weeks, and 30 days postoperatively). Demographic data, preoperative parameters, intraoperative details, and postoperative outcomes were recorded. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors.
Results: Among 252 patients enrolled, 41 (16.3%) developed SSIs, with 27 (65.9%) being superficial, 11 (26.8%) deep, and 3 (7.3%) organ/space infections. Open surgical approach (OR=4.78, 95% CI: 2.16-10.59, p<0.001), prolonged operative time >120 minutes (OR=3.21, 95% CI: 1.48-6.97, p=0.003), contaminated/dirty wounds (OR=2.87, 95% CI: 1.31-6.28, p=0.008), and preoperative albumin <3.0 g/dL (OR=2.63, 95% CI: 1.22-5.67, p=0.014) were identified as independent risk factors. Escherichia coli was the most commonly isolated pathogen (58.3%), with 76.4% showing resistance to the prophylactic antibiotics administered. The mean length of hospital stay was significantly longer in patients with SSI compared to those without (14.7±3.2 vs. 7.3±1.8 days, p<0.001).
Conclusion: The incidence of SSI following emergency abdominal surgery remains high, with identifiable modifiable risk factors. Implementation of targeted prevention strategies addressing surgical technique, operative duration, and preoperative optimization may reduce SSI rates and improve patient outcomes.
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References
World Health Organization. Surgical site infection. Geneva: WHO; 2018. Available from: https://www.who.int/teams/integrated-health-services/infection-prevention-control/surgical-site-infection
Centers for Disease Control and Prevention. Healthcare-associated infections: Surgical site infection. Atlanta: CDC; 2022.
Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784-791.
Bhangu A, Ademuyiwa AO, Aguilera ML, et al. 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.
World Society of Emergency Surgery. Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines. World J Emerg Surg. 2020;15:10.
Alkaaki A, Al-Radi OO, Khoja A, et al. Surgical site infection following abdominal surgery: a prospective cohort study. Can J Surg. 2019;62(2):111-117.
Zheng ZQ, Liu YY, Luo WW, et al. Prospective multicenter study on the incidence of surgical site infection after emergency abdominal surgery in China. Sci Rep. 2021;11:7878.
Mawalla B, Mshana SE, Chalya PL, et al. Incidence and risk factors for surgical site infections following emergency laparotomies: a prospective observational study. BMC Surg. 2022;22:234.
Al-Zacko SM, Zubeer HG, Mohammad SA. Surgical site infections after trauma laparotomy: an observational study from a major trauma center in Saudi Arabia. Saudi Med J. 2019;40(3):266-270.
Dodwad SM, Bhatnagar A, Kumar S, et al. Incidence and outcomes of surgical site infection following emergency laparotomy during the COVID-19 pandemic: a retrospective cohort study. Int J Surg Open. 2021;33:100348.
Huda F, Shasheendran S, Basu S, 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.
Kim JH, Kim J, Lee WJ, et al. Incidence and risk factors for surgical site infection after gastric surgery: a multicenter prospective cohort study. Infect Chemother. 2014;46(1):40-48.
Páramo-Zunzunegui J, Alonso-García M, Rodríguez-Villar D, et al. Incidence of surgical site infection and risk factors in rectal surgery: a prospective cohort study. Cir Esp. 2018;96(10):640-647.
Hassan SA, Khalil MA, Rahman MM, et al. Risk factors for surgical site infections in patients undergoing emergency surgery: a single-centre experience. In Vivo. 2021;35(6):3493-3500.
Zhang Y, Zheng QJ, Wang S, et al. The incidence and risk factors for surgical site infection after clean spinal operations: a prospective cohort study and review of the literature. Asian Spine J. 2020;14(5):632-641.
Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg. 2017;224(1):59-74.
Leaper DJ, Edmiston CE. World Health Organization: global guidelines for the prevention of surgical site infection. J Hosp Infect. 2017;95(2):135-136.
Tanner J, Padley W, Assadian O, et al. Do surgical care bundles reduce the risk of surgical site infections in patients undergoing colorectal surgery? A systematic review and cohort meta-analysis of 8,515 patients. Surgery. 2015;158(1):66-77.
Allegranzi B, Zayed B, Bischoff P, 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.
Weiser TG, Haynes AB, Molina G, et al. Size and distribution of the global volume of surgery in 2012. Bull World Health Organ. 2016;94(3):201-209F.
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