THE DISTRIBUTION OF PATHOGENS, RISK FACTORS AND THEIR ANTIMICROBIAL SUSCEPTIBILITY PATTERNS AMONG POST-SURGICAL SITE INFECTION IN RIZGARI TEACHING HOSPITAL IN ERBIL/KURDISTAN REGION/IRAQ

HAVAL HASSAN ABDULQADER; ABDULRAHMAN TOWFEEQ SAADI

doi:10.26682/sjuod.2019.22.1.1

HAVAL HASSAN ABDULQADER Rizgari Teaching Hospital/Erbil City, Kurdistan Region-Iraq
ABDULRAHMAN TOWFEEQ SAADI Dept. of Microbiology, College of Medicine, University of Duhok, Kurdistan Region-Iraq

DOI: https://doi.org/10.26682/sjuod.2019.22.1.1

Keywords: Post-Surgical Site Infections:, Hospital Acquired Infections;, E. coli and S. aureus.

Abstract

Objectives: to find out the incidence of Post-Surgical Site Infections, risk factors, types of the isolated bacteria and their antibiotic susceptibility patterns for patients admitted to Rizgari Teaching Hospital in Erbil city.

Methods: A prospective study was performed on 160 patients admitted to Rizgary Teaching Hospital for surgical operations over a period of six months (November 2015 to June 2016). Culture, identification and sensitivity tests for the isolated organisms from Post-Surgical Site Infections were done by using VITEK 2 systems in Laboratory of Rizgari Hospital.

Results: The incidence of PSSIs was 19.4%. E.coli was the most common isolated pathogen (29.2%) followed by Staphylococcus aureus (20.8%). Both Klebsiella pneumonia and Coagulase Negative Staphylococcus had 12.5% for each. Pseudomonas aeruginosa and Enterococcus faecium had 8.3% each and both Acinetobacter baumannii and Streptococcus spp. had only 4.2% each There was 100% resistance of E. coli regarding third generation cephalosporin but were 100% sensitive to Imipenem and meropenem. 60% of Staphylococcus aureus were resistant to oxacillin (MRSA). Smoking, past medical history, contaminated wounds, long duration of operation, and improper use of antibiotics were risk factors.

Conclusion: There was an increased rate of PSSIs due to risk factors. There were multi-resistant strains of isolated bacteria mainly E.coli and Staphylococcus aureus which denotes the abuse of antibiotics. This can be attributed to lack of proper guidance for the use of antibiotics both prophylactically and postoperatively.

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References

1. Anderson DJ. Epidemiology of surgical site infection in adults (2015). https://www.uptodate.com/contents/epidemiology-of-surgical-site-infection-in-adults.
2. Awad, SS. "Adherence to surgical care improvement project measures and postoperative surgical site infections". Surgical Infection (Larchmt) (2012). 13(4): 234-7.
3. Kirby JP and Mazuski JE. Prevention of surgical site infection Surg Clin North Am (2009); 89: 365-89 viii. doi: 10.1016/j.suc.2009.01.001. https://www.ncbi.nlm.nih.gov/pubmed/19281889.
4. Keping C, Jiawei L, Qingfang W, Nanyuan Y and Gohua X. Risk factors for surgical site infection in a teaching hospital: a prospective study of 1,138 patients. Patient Preference and Adherence (2015). 9: 1171–77.
5. Cantlon CA, Stemper ME. Schwan WR, Hoffman MA, Qutaishat SS. Significant pathogens isolated from surgical site infections at a community hospital in the Midwest. Am J Infect Control 2006; 34: 526 -29.
6. Wong ES. Surgical site infection. In: Mayhall CG, editor. Hospital Epidemiology and Infection Control. Philadelphia: Lippincott Williams & Wilkins; 2004. p. 287-310.
7. Therapeutic Guidelines: Antibiotic. Version 12. Melbourne: Therapeutic Guidelines Limited; 2003, 26:135.
8. Woodman N. World Health Organization Surgical Safety Checklist. ATOTW 325 (2016).https://www.aagbi.org/sites/default/files/325%20WHO%20Surgical%20Safety%20 Checklist.pdf.
9. Humphreys H. Preventing surgical site infection. Where now? J Hosp Infect 2009; 73: 316-322.
10. Gottrup F, Melling A and Hollander D A. World Wide Wounds: An overview of surgical site infections: aetiology, incidence and risk factors. (2005). http://www.worldwidewounds.com/2005/september/Gottrup/Surgical-Site-Infections-Overview.html
11. Shashidhar V, Kiran C and Anusha G. Multidrug resistant Gram-negative bacilli in lower respiratory tract infections.Iran J Microbiol. 2013; 5(4): 323–27.
12. Ahmed HJ, Nabeel A, Tharwat IS. The Effect of Perioperative use of Prophylactic Antibiotic on Surgical Wound Infection. Iraqi Postgraduate Medi. Jour. 2013: 12; 2.
13. Seyd MR, Mohammad I, Ahmad SK. and Ali J. Abdominal surgical site infections: incidence and risk factors at an Iranian teaching hospital. BMC Surg 2005, 5:2.
14. Gamal AK, Abdelmageed MK, Abdullah AA, Muhammed YA, Ahmed MZ, Muhammed YA, et al. Surgical Site Infection in a Teaching Hospital: A Prospective Study.Journal of Taibah university medical science.2011; 6(2):114-20
15. Bevin C, Yoon JC, Sandra HR, Yoko F, Matthew N, Elaine L. Gender Differences in Risk of Bloodstream and Surgical Site Infection. J Gen Intern Med 2013; 28(10):1318-25
16. Soad H, Tamer S, Elham H, Manal E, Emam A, Laurel L, et al. Incidence and modifiable risk factor of surveillance of surgical site infection in Egypt: A prospective study. American Jour. Of infection control 2012: 40; 426-30
17. Allegranzi B, Bagheri NS, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet 2011: 15;377:228-41
18. Harihara Y. Konishi T. Surgical site infection (SSI) surveillance. Nihon Geka Gakkai Zasshi. 2006;107 (5):230-4.
19. Yunzhou F. Zhaoxia W. Weiwei W. Li T. Hongbo J. Lihong T. Yuguang C. et al. The Incidence and Distribution of Surgical Site Infection in Mainland China: A Meta-Analysis of 84 Prospective Observational Studies. Sci Rep. 2014; 4: 6783.
20. Koigi-Kamau R, Kabare LW, Wanyoike-Gichuhi J. Incidence of Wound Infection after Caeserean Delivery in a Distinct Hospital in central Kenya. East Afr Med J. 2005; 82(7):357-61
21. Muhemmad SA, Farkhanda JD, Ahsan AL, Faisal B, Noor MK. Journal of surgery Pakistan (International). 2011;16(1): 33-7.
22. Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System.Am J Med 91, 152S - 78 (1991).
23. Kaye KS, Schmader KE. & Sawyer R. Surgical site infection in the elderly population. Clin Infect Dis 39, 1835–41 (2004).

24. Haley RW, Culver DH, Morgan WM, White JW, Emori TG, Hooton TM. Identifying patients at high risk of surgical wound infection. A simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol 1985; 121: 206–15.
25. Tsai PS. Hsu CS. Fan YC. & Huang CJ. General anaesthesia is associated with increased risk of surgical site infection after Caesarean delivery compared with neuraxial anaesthesia: a population-based study. Br J Anaesth 2011; 107: 757–61
26. Pear SM. Relationship of Perioperative Hyperglycemia and Major Infections in Cardiac Surgery Patients. University of Arizona; 2004.
27. Reynolds R, Potz N, Colman M, Williams A, Livermore D, MacGowan A. Antimicrobial susceptibility of the pathogens of bacteraemia in the UK and Ireland 2001– 2002: the BSAC Bacteraemia Resistance Surveillance Programme. J. Antimicrob.Chemother. 2004; 1: 3- 12.
28. Ali AA, and Mazin AH. How Good is Compliance with Surgical Antibiotic Prophylaxis Guidelines in Erbil/ Iraq. 2nd International Conference on Medical, Biological and Pharmaceutical Sciences (ICMBPS'2013). London (UK) 2013.
29. Parulekar L, Soman R, Singhal T, Rodrigues C, Dastur FD, Mehta A. How good is compliance with surgical antibiotic prophylaxis guidelines in a tertiary care private hospital in India? A prospective study. Indian J Surg 2009; 71:15–8.
30. 48. Askarian M, Moravveji AR, Mirkhani H, Namazi S, Weed H. Adherence to American Society of Health-System Pharmacists surgical antibiotic prophylaxis guidelines in Iran. Infect Control Hosp Epidemiol 2006; 27:876–8. 54
31. Al-Momany NH, Al-Bakri AG, Makahleh ZM, Wazaify MMB. Adherence to international antimicrobial prophylaxis guidelines in cardiac surgery: a Jordanian study demonstrates need for quality improvement. . J Managed Care Pharmacy JMCP 2009; 15 (3): 262-71.
32. Hosoglu S, Sunbul M, Erol S, Altindis M, Caylan R, Demirdag K et al. A national survey of surgical antibiotic prophylaxis in Turkey. Infect Control Hosp Epidemiol 2003; 24:758–61.
33. Leaper DJ. Risk factors for and epidemiology of surgical site infections. Surg Infect (Larchmt). 2010; 11(3): 283-7.
34. Al-Ali KY. Evaluation of surveillance for surgical site infections and Drug Susceptibility patterns, Taif, saudi Arabia annals of clinical and lab. reaearch.2016;4:78
35. Antibiotic prophylaxis in surgery a national guideline.SIGN.2008:104. www. sign. ac.uk
36. Shankar VG. Srinivasan K. Sistla SC. jagdish S. Prophylactic Antibiotic in open mesh repair of inguinal hernia- A randomized control trial.International journal of surgery. 2010, 8:4