Sweta Shah1, Tanu Singhal2, Reshma Naik1. 1. Department of Infection Prevention and Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India. 2. Department of Infection Prevention and Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India. Electronic address: tanu.singhal@relianceada.com.
Abstract
BACKGROUND: There is limited single-center data on the incidence and microbial etiology of surgical site infections (SSIs) from developing countries. METHODS: This is a prospective observational study over 4-year period (April 2009-March 2013) at a 750-bed private multispecialty hospital in Mumbai, India, among patients undergoing clean and clean-contaminated surgeries. Standard guidelines for preventing, classifying, and diagnosing SSI were followed. RESULTS: A total of 24,355 patients underwent clean and clean-contaminated surgeries during the study period. The overall SSI rate was 1.6% (389 cases). The SSI rate in clean surgeries was 1.57%, and the SSI rate in clean-contaminated surgeries was 1.64%. Of the SSIs, 66% were caused by gram-negative bacilli (GNB) (Escherichia coli [22.9%], Klebsiella [18.2%], Pseudomonas [12.7%], and Acinetobacter [6.0%] were the top 4), 31.7% were caused by gram-positive bacilli (Staphylococcus: 70.5%, Enterococcus: 23.8%, Streptococcus: 1.8%), and 2.1% were caused by Candida. A total of 64% of the E coli and Klebsiella isolates were extended spectrum β-lactamase producing, 6% of the GNB were carbapenem resistant, and only 17.3% of S aureus isolates were methicillin resistant. CONCLUSION: Although the SSI rate is comparable with established international benchmarks, increasing prevalence of antimicrobial resistance in GNB is a matter of serious concern.
BACKGROUND: There is limited single-center data on the incidence and microbial etiology of surgical site infections (SSIs) from developing countries. METHODS: This is a prospective observational study over 4-year period (April 2009-March 2013) at a 750-bed private multispecialty hospital in Mumbai, India, among patients undergoing clean and clean-contaminated surgeries. Standard guidelines for preventing, classifying, and diagnosing SSI were followed. RESULTS: A total of 24,355 patients underwent clean and clean-contaminated surgeries during the study period. The overall SSI rate was 1.6% (389 cases). The SSI rate in clean surgeries was 1.57%, and the SSI rate in clean-contaminated surgeries was 1.64%. Of the SSIs, 66% were caused by gram-negative bacilli (GNB) (Escherichia coli [22.9%], Klebsiella [18.2%], Pseudomonas [12.7%], and Acinetobacter [6.0%] were the top 4), 31.7% were caused by gram-positive bacilli (Staphylococcus: 70.5%, Enterococcus: 23.8%, Streptococcus: 1.8%), and 2.1% were caused by Candida. A total of 64% of the E coli and Klebsiella isolates were extended spectrum β-lactamase producing, 6% of the GNB were carbapenem resistant, and only 17.3% of S aureus isolates were methicillin resistant. CONCLUSION: Although the SSI rate is comparable with established international benchmarks, increasing prevalence of antimicrobial resistance in GNB is a matter of serious concern.
Authors: Darren Wong; Travis B Nielsen; Robert A Bonomo; Paul Pantapalangkoor; Brian Luna; Brad Spellberg Journal: Clin Microbiol Rev Date: 2017-01 Impact factor: 26.132