Abstract:
Surgical site infections (SSI) remain a major clinical problem contributing to significantly high morbidity, mortality, and patient hospital costs. Postoperative infections have always been a feature of human life and sepsis in modern surgery continues to be a significant problem for healthcare practitioners across the globe. Patients that are undergoing surgery or surgical procedures are at risk of acquiring infection at the site of incision as result of the same procedure. SSIs are real risks associated with any surgical procedure and represent a significant burden contributing to morbidity and mortality, and increased cost to health services around the world. Despite Surgical site infection being a relatively serious problem in our health institution, there are scanty published reports on the bacterial pathogens (especially their antibiograms or molecular epidemiology) that are
involved in SSIs in our local hospitals. The sporadic reports from the public sector
hospitals are mainly from the Microbiology laboratory records which may not
show the complete clinical picture. These reports from the records have been used
to estimate or predict this predicament. This study aimed at determining the
occurrence of SSI, pathogens associated with SSI, the antibiograms of the
causative pathogens and specific risk factors associated with SSI at Aga Khan
University Hospital, Nairobi (AKUH-N). It was a prospective observational study
with patient follow-up until the 30th postoperative day, carried out at AKUH-N.
The study recruited 175 respondents (patients) admitted for general surgical
procedures from March 2008 to December 2008 at the hospital and were eligible
to take part in the study. To eligible respondents, questionnaires were
administered; preoperative and intra-operative samples were obtained for culture.
After surgery patients were observed for symptoms of infection. Reviews were
done through the consulting clinics, breast clinic and casualty dressing clinic. In
cases of infection, pus swabs were obtained for culture. All the samples were
transported to the laboratory for culture. Cultures were done using standard
bacteriological procedures. The samples were cultured in Blood agar, MacConkey
and Chocolate agar. Sensitivity was done on Mueller Hinton Agar medium. Disc
diffusion was used to determine the antimicrobial susceptibility patterns to a panel
of commonly available drugs against the pathogens implicated in the infection.
Patients’ data were managed using EPI-INFO statistical program and analyzed
using SPSS version 17, mean, median, frequencies and cross tabs were used to
interpret the data. The findings were presented in tables and pie chart. The study
found out that the SSI incidence rate was 6.8%. Pathogens isolated from SSI
included S. aureus (30%), Coagulase negative Staphylococcus (16%), Klyuvera
spp. (13%), E. coli (13%), P. aeruginosa (13%), Klebsiella spp. (9%) and other
Gram negative. S. aureus was the most prevalent pathogen isolated from infected
surgical site with 10% ORSA rate. Vancomycin was potent on Gram positive
bacteria. Preoperative stay ≥ 2days (p=0.002) and wound class (p=0.003) at p<
0.05 (95% confidence interval) were the risk factors associated with SSI among
patients admitted for general surgical procedure at the hospital during the study
period. From the findings of this study, it can be concluded that incidence rate of
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SSI of 6.8% is relatively lower than documented SSI incidence rates in other
studies in the Kenya. S. aureus (30%) is the most prevalent pathogens associated
with SSI at AKUH-N, similar to findings from other studies done in the region.
Ampicillin and Cotrimoxazole are not potent against pathogens associated with
SSI in AKUH-N. Prolonged hospital stay and dirty wounds are the main risk
associated with post surgical sepsis at the AKUH-N.