Evaluation of antimicrobial prophylaxis use and rate of surgical site infection in surgical ward of Wachemo University Nigist Eleni Mohammed Memorial Hospital, Southern Ethiopia: Prospective cohort study

Abstract

Background: Surgical site infection (SSI) is the foremost infection in the overall patient population, affecting up to 66% of operated patients and with a frequency up to nine times more than in developed countries. This study aimed to determine the rate, associated factors of surgical site infection, and identification of causative agents and their antimicrobial susceptibility in surgical ward of Wachemo University Nigist Eleni Mohamed Memorial Hospital (WUNEMMH), Southern Ethiopia. Method: Prospective cohort study involving 255 patients who underwent surgical procedure in WUNEMMH from January 1 to September 1, 2017. We extracted data from medical chart, operational and anesthesia note by direct observation and interviewer administered semi-structured questionnaire which was validated. We collected wound specimens and processed it based on standard operating procedure, and disc-diffusion antibiotic susceptibility test was done. Data analysis was done using SPSS version 22.0. Factors significantly associated were identified using logistic regression model at P-value < 0.05 and 95%CI. Result: Forty-two patients (16.5%) developed SSIs. The most causative organism of surgical site infection was Klebsiella pneumoniae (60%).Ciprofloxacin and ceftriaxone were sensitive antibiotics. Surgery waiting time more than 7 days [ARR = 2.48 (95%CI(1.28-4.79),P = 0.007], Operation time more than 1 h.[ARR = 2.13(95%CI(1.18-3.86),P = 0.012], and administering antibiotic before 1 h of operation [ARR = 5.05(95%CI(1.79-14.21),P = 0.002], smoking [ARR = 8.01 (95% CI (2.15 29.84),P = 0.002] were independently associated with surgical site infections. Conclusion: The rate of SSI was relatively high. Klebsiella pneumoniae was found to be the most causative agent for SSI. Organisms causing SSI were sensitive to commonly used antimicrobial agents in WUNEMMH.