Pattern of antibiotics use, incidence and predictors of surgical site infections in a Tertiary Care Teaching Hospital

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Abstract

Objective

Surgical site infections (SSIs) were the most common healthcare-associated infection mainly in developing countries. Inappropriate use of surgical antibiotic prophylaxis, in terms of antibiotic choice, timing, and duration, can lead to the selection of resistant microorganisms and high costs. The aim of this study was to investigate the pattern of antibiotic use, incidence and predictors of SSIs at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

Results

From 131 patients, 55.7% were male study participants. Ninety (68.7%) patients received preoperative prophylaxis. Ceftriaxone was the most 76 (84.5%) prescribed agent for prophylaxis. Twenty-seven (20.6%) patients developed surgical site infection. Previous surgery AOR = 3.22 (95% CI [1.14–9.13]) and alcohol use AOR = 7.04 (95% CI [2.56–23.12, p = 0.000]) were independent predictors of SSIs in multivariate logistic regression analysis.

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The online version of this article (10.1186/s13104-018-3643-8) contains supplementary material, which is available to authorized users.

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Risk factors, perceptions and practices associated with Taenia solium cysticercosis and its control in the smallholder pig production systems in Uganda: a cross-sectional survey

Joseph Kungu, Michel M Dione, Francis Ejobi … (2017)

Background Prevalence studies report Taenia solium cysticercosis in pig and human populations in Uganda. However, the factors influencing occurrence in smallholder pig production systems are not well documented and little is known about farmers’ perceptions of T. solium cysticercosis or farmer practices that could reduce transmission. Methods To determine the risk factors, perceptions and practices regarding T. solium cysticercosis, a household survey using a semi-structured questionnaire was conducted in 1185 households in the rural and urban pig production systems in Masaka, Mukono and Kamuli Districts. Logistic regression was used to measure associations of risk factors with infection. Performance scores were calculated to summarise perceptions and practices of farmers regarding taeniosis, human cysticercosis and porcine cysticercosis as well as farmer behavior related to control or breaking transmission. Results Pig breed type, farmers’ knowledge about transmission, sources of water used, and pig keeping homes where family members were unable to use the latrine were all significantly associated with T. solium cysticercosis in pigs. Performance scores indicated that farmers were more aware of taeniosis (63.0%; 95% Confidence Interval 60.0-65.8) than human or porcine cysticercosis; only three farmers (0.3%, 95% CI = 0.1–0.8) had knowledge on all three conditions. More farmers reported that they dewormed pigs (94.1%) than reported deworming themselves and their family members (62.0%). Albendazole was the most commonly used drug for deworming both pigs and humans (85.0 and 81.5% respectively). Just over half (54.6%) of the farmers interviewed had clean water near the latrines for washing hands. Of these, only 41.9% used water with soap to wash hands after latrine use. Conclusion Factors that significantly influenced occurrence of T. solium cysticercosis in pigs were identified. Farmers had some knowledge about the disease but did not link taeniosis, human cysticercosis, and porcine cysticercosis. Therefore, there is need to employ strategies that raise awareness and interrupt transmission.

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Incidence and predictors of surgical site infections following caesarean sections at Bugando Medical Centre, Mwanza, Tanzania

Filbert Mpogoro, Stephen E. Mshana, Mariam M. Mirambo … (2014)

Background Surgical site infection (SSI) is the second most common infectious complication after urinary tract infection following a delivery by caesarean section (CS). At Bugando Medical Centre there has no study documenting the epidemiology of SSI after CS despite the large number of CSs performed and the relatively common occurrence of SSIs. Methods This was a prospective cohort study involving pregnant women who underwent a CS between October 2011 and February 2012 at Bugando Medical Centre. A total of 345 pregnant women were enrolled. Preoperative, intraoperative and postoperative data were collected using a standardized questionnaire. Wound specimens were collected and processed as per standard operative procedures; and susceptibility testing was carried out using a disc diffusion technique. Data was analyzed using STATA version 11. Results The overall cumulative incidence of SSI was 10.9% with an incidence rate of 37.5 per 10,000 people/day (95% CI, 26.8-52.4). The median time from CS to the development of SSI was 7 days (interquartile range [IQR] = 6–9 days). Six independent risk factors for post caesarean SSI as identified in this study by multivariate analysis are: hypertensive disorders of pregnancy (HR: 2.5; 95% CI, 1.1-5.6; P = 0.021), severe anaemia (HR: 3.8; 95% CI, 1.2-12.4, P = 0.028), surgical wound class III (HR: 2.4; 95% CI, 1.1-5.0; P = 0.021), multiple vaginal examinations (HR: 2.5; 95% CI, 1.2-5.1; P = 0.011), prolonged duration of operation (HR: 2.6; 95% CI, 1.2-5.5; P = 0.015) and an operation performed by an intern or junior doctor (HR: 4.0; 95% CI, 1.7-9.2; P = 0.001). Staphylococcus aureus was the most common organism (27.3%), followed by Klebsiella pneumoniae (22.7%). Patients with a SSI had a longer average hospital stay than those without a SSI (12.7 ± 6.9 vs. 4 ± 1.7; P < 0.0001) and the case fatality rate among patients with a SSI was 2.9%. Conclusion SSIs are common among women undergoing CSs at Bugando Medical Centre. SSIs were commonly associated with multiple factors. Strategies to control these factors are urgently needed to control SSIs post CS at Bugando Medical Centre and other centres in developing countries.

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Predictive factors for surgical site infection in general surgery.

M Haridas, Mark Malangoni (2008)

Global parameters, such as wound class, the American Society of Anesthesiologists' physical classification score, and prolonged operative time, have been associated with the risk of surgical site infection (SSI). We hypothesized that additional risk factors for SSI would be identified by controlling for these parameters and that deep and organ/space SSI may have different risk factors for occurrence. A retrospective review was performed on general and vascular surgical patients who underwent an operation between June 2000 and June 2006 at a single institution. Patients with SSI were matched with a case-control cohort of patients without infection (no SSI) according to age, sex, ASA score, wound class, and type of operative procedure. Data were analyzed using bivariate and regression analyses. Overall, 10,253 general surgical procedures were performed during the 6-year period; 316 patients (3.1%) developed SSI. In all, 300 patients with 251 superficial (83.6%), 22 deep (7.3%), and 27 organ/space (9%) SSIs were matched for comparison. Multivariate logistic regression analysis identified previous operation (odds ratio [OR], 2.4; 95% confidence interval [CI] = 1.6-3.7), duration of operation >or=75th percentile (OR, 1.8; 95% CI = 1.2-2.8), hypoalbuminemia (OR, 1.8; 95% CI = 1.1-2.8), and a history of chronic obstructive pulmonary disease (OR, 1.7; 95% CI = 1.0-2.8) as independent risk factors for SSI. Only hypoalbuminemia (OR, 2.9; 95% CI = 1.4-6.3) and a previous operation (OR, 2.0; 95% CI = 1.0-4.4) were significantly associated with deep or organ/space infections. These results demonstrate additional factors that increase the risk of developing SSI. Deep and organ/space infections have a different risk profile. This information should guide clinicians in their assessment of SSI risk and should identify targets for intervention to decrease the incidence of SSI.

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Author and article information

Contributors

Ezaedin Halawi: ibnhalawi@gmail.com

Tamrat Assefa: tamrat.assefa@aau.edu.et

Sadikalmahdi Hussen: sadikalmahdi.hussen@aau.edu.et

Journal

Journal ID (nlm-ta): BMC Res Notes

Journal ID (iso-abbrev): BMC Res Notes

Title: BMC Research Notes

Publisher: BioMed Central (London )

ISSN (Electronic): 1756-0500

Publication date (Electronic): 31 July 2018

Publication date PMC-release: 31 July 2018

Publication date Collection: 2018

Volume: 11

Electronic Location Identifier: 538

Affiliations

ISNI 0000 0001 1250 5688, GRID grid.7123.7, Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, , Addis Ababa University College of Health Sciences, ; P.O.Box:1176, Addis Ababa, Ethiopia

Article

Publisher ID: 3643

DOI: 10.1186/s13104-018-3643-8

PMC ID: 6069967

PubMed ID: 30064487

SO-VID: 871ebc9d-3924-4aa6-ad5d-615d6b324d4a

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 6 June 2018

Date accepted : 24 July 2018

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ScienceOpen disciplines: Medicine

Keywords: pre and postoperative antimicrobial prophylaxis,tikur anbessa specialized hospital

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ScienceOpen disciplines: Medicine

Keywords: pre and postoperative antimicrobial prophylaxis, tikur anbessa specialized hospital

Pattern of antibiotics use, incidence and predictors of surgical site infections in a Tertiary Care Teaching Hospital

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Artificial Intelligence in Medicine

Most cited references 20

Risk factors, perceptions and practices associated with Taenia solium cysticercosis and its control in the smallholder pig production systems in Uganda: a cross-sectional survey

Incidence and predictors of surgical site infections following caesarean sections at Bugando Medical Centre, Mwanza, Tanzania

Predictive factors for surgical site infection in general surgery.

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