Abstract:

Background: Surgical site infections continue to be a major source of morbidity and mortality in developing countries despite recent advances in aseptic technique. Factors responsible for this have not been established in our setting. The aim of this study was to establish the prevalence, patterns and factors associated with surgical site infection in our local setting.

Patients and Methods: This was a cross-sectional study involving all patients who underwent major surgery at Bugando Medical Centre (BMC) between November 2009 and January 2010. After informed written consent for the study and HIV testing, all patients who met the inclusion criteria were consecutively enrolled into the study. Specimens of pus swabs were collected aseptically and analyzed in the laboratory for colony characteristics and Grams technique, biochemical tests and sensitivity testing. Data were collected using a pre-tested, coded questionnaire and analyzed using SPSS software version 15.

Results: A total of 250 patients undergoing major surgery were studied. Their ages ranged from 3 months to 80 years with a mean of 38.08 years. The modal age group was 31-40 years. There were 116 (46.4%) males and females were 134 (53.6%) with the male to female ratio of 1: 1.2. SSI was detected in 65 patients (26.0%), of which 56 (86.2%) were superficial SSI. Staphylococcus aureus 16 (28.6%) was the most organism isolated, of which 3 (18.8%) were MRSA positive. This was followed by Escherichia coli 14 (25.0%) and Klebsiella pneumoniae 10 (17.9%). Among the Escherichia coli and Klebsiella pneumoniae isolates, 6 (42.8%) and 3 (30.0%) respectively were ESBL positive. Most organisms in this study were sensitive to meropenem 27 (100%) and imipenem 23 (100%). The majority of organisms exhibited multi-resistant to all the commonly used antibiotics. All organisms exhibited 100% resistant to ampicillin. Thirty-seven patients (14.8%) were HIV positive with a mean CD4 count of 296.35 cells/l. Using multivariate logistic regression analysis, pre-morbid illness, ASA classification, use of drain, skin preparation, wound class, duration of operation, type of suture material, HIV positivity and CD4 count were found to be statistically significantly associated with SSI

Conclusion: SSI rate in the surgical wards of Bugando Medical Centre was high in comparison to developed countries. Surveillance system for SSI and hospital guidelines on antibiotic use among surgical patients should be developed and adhered to. Prevention strategies focusing on the factors which were found to be associated with SSI in necessary in order to reduce the rate of SSI in our setting.