Study of surgical site infections following gynaecological surgeries in a tertiary care hospital
Authors
-
PG Resident, Department of Obstetrics & Gynaecology, Dr. Vasantrao Pawar Medical College Hospital & Research Centre, Nashik - 422003, Maharashtra, India ,IN
Snehal Ashok Naphade -
Professor & Head, Department of Obstetrics & Gynaecology, Dr. Vasantrao Pawar Medical College Hospital & Research Centre, Nashik - 422003, Maharashtra, India ,INKiran Patole
Keywords:
Surgical Site infection, SSI, gynaecological Surgery, deep infections.Abstract
Background: It was a prospective longitudinal study designed to study the incidence, risk factors and outcome of gynaecological surgeries in a tertiary care hospital.
Methods: We included all the gynaecological surgeries performed in our unit. All the cases operated outside the hospital, cases with history of surgery in past 30 days, diagnosed cases of HIV and hepatitis B were excluded. We compared the cases with SSI with the age adjusted control group of non infected patients.
Results: We found that the incidence of SSI was 10.35%. Amongst the various factors studied, we found that BMI, history of diabetes, per vaginal discharge, longer preoperative hospital stay, severe anaemia, ASA grade III, open abdominal approach, vertical incisions, class II surgeries were associated with SSI. Staphylococcus aureus is the commonest microbe isolated from surgical wounds. SSI cases have significantly longer hospital stay.
Conclusion: SSI was significantly associated with BMI, diabetes, per vaginal discharge, pre-operative hospitalization, severe anaemia, ASA grade III, open abdominal route of surgery, class II surgery, vertical incisions were associated with surgical site infection.
Downloads
Published
Issue
Section
References
Anderson DJ. Prevention of surgical site infection: beyond SCIP. AORN J. 2014 Feb;99(2):315–9.
Colling KP, Glover JK, Statz CA, Geller MA, Beilman GJ. Abdominal Hysterectomy : Reduced Risk of Surgical Site Infection Associated with Robotic and Laparoscopic Technique. 2015;16(X):1–6.
Lake AG, Mcpencow AM, Dick-biascoechea MA, Martin DK, Erekson EA. Surgical site infection after hysterectomy. 2013;209(5).
de Araújo Madeira MZ, Trabasso P. Surgical site infections in women and their association with clinical conditions. Rev Soc Bras Med Trop. 2014 Jul;47(4):457–61.
Buitrón García R, López Delgado M, Basurto Kuba E, Romero Cabello R, Chessin A, Carrasco Rendón J. [Infection of the surgical site. Experience of two years in the gynecology and obstetric service of Mexican General Hospital]. Ginecol Obstet Mex. 2006 May;74(5):260–4.
Baatrup G, Nilsen RM, Svensen R, Akselsen PE, Smith R, Bohl J, et al. Increased incidence of postoperative infections during prophylaxis with cephalothin compared to doxycycline in intestinal surgery. BMC Surg. BioMed Central; 2009 Dec;9(1):17.
Lachiewicz MP, Moulton LJ, Jaiyeoba O. Infection Prevention and Evaluation of Fever After Laparoscopic Hysterectomy. JSLS J Soc Laparoendosc Surg. Society of Laparoendoscopic Surgeons; 2015;19(3).
R. S, S.Y. P, R.H. B, S.L. D, Shree R, Park SY, et al. Surgical Site Infection following Cesarean Delivery: Patient, Provider, and Procedure-Specific Risk Factors. Am J Perinatol. 2015 Jan;33(2):157–64.
Lima JLD de A, De Aguiar RALP, Leite HV, Silva HHRM, de Oliveira WM, Sacramento JPT da C, et al. Surveillance of surgical site infection after cesarean section and time of notification. Am J Infect Control. Elsevier Inc.; 2016 Mar;44(3):273–7.
Olsen MA, Butler AM, Willers DM, Gross GA, Hamilton BH, Fraser VJ. Attributable costs of surgical site infection and endometritis after low transverse cesarean delivery. Infect Control Hosp Epidemiol. 2010 Mar;31(3):276–82.
Assawapalanggool S, Kasatpibal N, Sirichotiyakul S, Arora R, Suntornlimsiri W. Risk factors for cesarean surgical site infections at a Thai-Myanmar border hospital. Am J Infect Control. Elsevier Inc.; 2016;1–6.
Thelwall S, Harrington P, Sheridan E, Lamagni T. Impact of obesity on the risk of wound infection following surgery: Results from a nationwide prospective multicentre cohort study in England. Clin Microbiol Infect. Elsevier Ltd; 2015 Nov;21(11):1008.e1–1008.e8.
Chapman JS, Roddy E, Westhoff G, Simons E, Brooks R, Ueda S, et al. Post-operative enteral immunonutrition for gynecologic oncology patients undergoing laparotomy decreases wound complications. Gynecol Oncol. 2015 Jun;137(3):523–8.
Mahdi H, Goodrich S, Lockhart D, DeBernardo R, Moslemi-Kebria M. Predictors of Surgical Site Infection in Women Undergoing Hysterectomy for Benign Gynecologic Disease: A Multicenter Analysis Using the National Surgical Quality Improvement Program Data. J Minim Invasive Gynecol. Elsevier Ltd; 2014 Sep;21(5):901–9.
Fitzwater JL, Tita ATN. Prevention and Management of Cesarean Wound Infection. Obstet Gynecol Clin North Am. 2014 Dec;41(4):671–89.
Mikhail E, Miladinovic B, Velanovich V, Finan MA, Hart S, Imudia AN. Association between obesity and the trends of routes of hysterectomy performed for benign indications. Obstet Gynecol. 2015 Apr;125(4):912–8.
Uppal S, Harris J, Al-Niaimi A, Swenson CW, Pearlman MD, Reynolds RK, et al. Prophylactic Antibiotic Choice and Risk of Surgical Site Infection After Hysterectomy. Obstet Gynecol. 2016 Feb;127(2):321–9.
Lachiewicz MP, Moulton LJ, Jaiyeoba O. Pelvic Surgical Site Infections in Gynecologic Surgery. Hindawi Publishing Corporation; 2015;2015(2).
Olsen MA, Higham"Kessler J, Yokoe DS, Butler AM, Vostok J, Stevenson KB, et al. Developing a Risk Stratification Model for Surgical Site Infection after Abdominal Hysterectomy. Infect Control Hosp Epidemiol. 2009 Nov;30(11):1077–83.
Bangal VB, Borawake SK, Shinde KK, Gavhane SP. Study of Surgical Site Infections following Gynaecological Surgery at tertiary care teaching hospital in Rural India. Int J Biomed Res. 2014 Feb;5(2):113.
Bangal VB, Borawake SK, Shinde KK, Gavhane SP, Bangal Professor VB. Study of Surgical Site infections following gynaecological surgery at tertiary care teaching hospital in Rural India. Int J Biomed Res. 2014;ISSN:976–9633.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Infect Control Hosp Epidemiol. 1999 Apr 2;20(04):247–80.
Farret TCF, Dallé J, da Silva Monteiro V, Riche CVW, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: a case-control study. Braz J Infect Dis. Elsevier Editora Ltda; 2014;19(x x):1–5.
Akasaka J, Furukawa N, Shigemitsu A, Kanayama S, Kawaguchi R, Kobayashi H. Risk factors for wound complications after surgery for gynecologic malignancies. Int J Gynecol Cancer. 2013;23(8):1501–5.
Mahdi H, Goodrich S, Lockhart D, Debernardo R, Moslemi-kebria M. SC. J Minim Invasive Gynecol. Elsevier Ltd; 2014;
Martin ET, Kaye KS, Knott C, Nguyen H, Santarossa M, Evans R, et al. Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis. Infect Control Hosp Epidemiol. NIH Public Access; 2016 Jan;37(1):88–99.
Morgan DM, Swenson CW, Streifel KM, Kamdar NS, Uppal S, Burgunder-Zdravkovski L, et al. Surgical site infection following hysterectomy: adjusted rankings in a regional collaborative. Am J Obstet Gynecol. 2016 Feb;214(2):259.e1–8.
Krieger Y, Walfisch A, Sheiner E. Surgical site infection following cesarean deliveries: trends and risk factors. J Matern Fetal Neonatal Med. 2016;7058(June):1–5.
de Araújo Madeira MZ, Trabasso P, de Araújo Madeira MZ, Trabasso P. Surgical site infections in women and their association with clinical conditions. Rev Soc Bras Med Trop. SBMT; 2014 Jul;47(4):457–61.
Morgan DM, Swenson CW, Streifel KM, Kamdar NS, Uppal S, Burgunder-Zdravkovski L, et al. Surgical site infection following hysterectomy: Adjusted rankings in a regional collaborative. Am J Obstet Gynecol. Elsevier Inc.; 2016 Feb;214(2):259e1–259e8.
van Ramshorst GH, Nieuwenhuizen J, Hop WCJ, Arends P, Boom J, Jeekel J, et al. Abdominal Wound Dehiscence in Adults: Development and Validation of a Risk Model. World J Surg. 2009 Nov;34(1):20–7.
HODGES KR, DAVIS BR, SWAIM LS. Prevention and Management of Hysterectomy Complications. Clin Obstet Gynecol. 2014 Mar;57(1):43–57.
Petrosillo N, Drapeau CMJ, Nicastri E, Martini L, Ippolito G, Moro ML. Surgical site infections in Italian Hospitals: a prospective multicenter study. BMC Infect Dis. 2008 Jan;8:34.
Kamat US, Fereirra AMA, Kulkarni MS, Motghare DD. A prospective study of surgical site infections in a teaching hospital in Goa. Indian J Surg. 2008 Jun;70(3):120–4.
Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, oman. Sultan Qaboos Univ Med J. 2014 May;14(2):e211–7.
Bakkum-Gamez JN, Dowdy SC, Borah BJ, Haas LR, Mariani A, Martin JR, et al. Predictors and costs of surgical site infections in patients with endometrial cancer. Gynecol Oncol. NIH Public Access; 2013 Jul;130(1):100–6.
Lewis SM, Bain BJ, Bates I, Bain BJ, Lewis SM, Bates I. Chapter 3 – Basic haematological techniques. In: Dacie and Lewis Practical Haematology. 2006. p. 25–57.
Bhadauria AR, Hariharan C. Clinical study of post operative wound infections in obstetrics and gynaecological surgeries in a tertiary care set up. Int J Reprod Contracept Int J Reprod Contracept Obs Gynecol. 2013;22(4):631–8.
Shahane- V. Surgical site infections: A one year prospective study in a tertiary care center. Int J Heal Sci Qassim Univ. 2012;6(1).
Roy S, Patkar A, Daskiran M, Levine R, Hinoul P, Nigam S. Clinical and economic burden of surgical site infection in hysterectomy. Surg Infect (Larchmt). 2014 Jun;15(3):266–73.
Brummer THI, Jalkanen J, Fraser J, Heikkinen A-M, Kauko M, Makinen J, et al. FINHYST, a prospective study of 5279 hysterectomies: complications and their risk factors. Hum Reprod. 2011 Jul 1;26(7):1741–51.
Mpogoro FJ, Mshana SE, Mirambo MM, Kidenya BR, Gumodoka B, Imirzalioglu C. Incidence and predictors of surgical site infections following caesarean sections at Bugando Medical Centre, Mwanza, Tanzania. Antimicrob Resist Infect Control. 2014;3(1):25.
Leong G, Wilson J, Charlett A. Duration of operation as a risk factor for surgical site infection: comparison of English and US data. J Hosp Infect. 2006 Jul;63(3):255–62.
Killian CA, Graffunder EM, Vinciguerra TJ, Venezia RA. Risk factors for surgical-site infections following cesarean section. Infect Control Hosp Epidemiol. 2001 Oct;22(10):613–7.
Fan Y, Wei Z, Wang W, Tan L, Jiang H, Tian L, et al. The Incidence and Distribution of Surgical Site Infection in Mainland China: A Meta-Analysis of 84 Prospective Observational Studies. Sci Rep. 2014 Oct;4:6783.
Guohua X, cheng keping, Li J, Kong Q, Wang C, Nanyuan Y. Risk factors for surgical site infection in a teaching hospital: a prospective study of 1,138 patients. Patient Prefer Adherence. 2015 Aug;9:1171.
De Nardo P, Gentilotti E, Nguhuni B, Vairo F, Chaula Z, Nicastri E, et al. Post-caesarean section surgical site infections at a Tanzanian tertiary hospital: A prospective observational study. J Hosp Infect. Elsevier Ltd; 2015 Aug;93(4):1–5.
Tuuli MG, Liu J, Stout MJ, Martin S, Cahill AG, Odibo AO, et al. A Randomized Trial Comparing Skin Antiseptic Agents at Cesarean Delivery. N Engl J Med. 2016 Feb 18;374(7):647–55.
Johnson ET. Nosocomial infection: update. J Natl Med Assoc. National Medical Association; 1983 Feb;75(2):147–54.
Emori TG, Gaynes RP. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev. 1993 Oct;6(4):428–42.
Giacometti A, Cirioni O, Schimizzi AM, Del Prete MS, Barchiesi F, D'Errico MM, et al. Epidemiology and microbiology of surgical wound infections. J Clin Microbiol. 2000 Feb;38(2):918–22.
Ming DY, Chen LF, Miller BA, Sexton DJ, Anderson DJ. The Impact of Depth of Infection and Postdischarge Surveillance on Rate of Surgical-Site Infections in a Network of Community Hospitals. Infect Control Hosp Epidemiol. 2015 Jan;33(03):276–82.
Lazenby GB, Soper DE. Prevention, Diagnosis, and Treatment of Gynecologic Surgical Site Infections. Obstet Gynecol Clin North Am. 2010 Sep;37(3):379–86.
