Surgical site infection following emergency laparotomy for bowel surgery at Kenyatta national hospital

Abstract

A seven (7) month descriptive cross sectional study on surgical site infection (SSI) following emergency laparotomy for bowel pathology was conducted in the general surgical unit at Kenyatta national hospital (KNH). Incidence of SSI, patient related risk factors and microbial profile were described. Overall SSI incidence was 30.8%. Most of patients were young with mean age of 35.48± 1.282 years who were predominantly male (76.7%). The highest incidence of SSI were associated with alcohol consumption and cigarette use, dirty wounds, prolonged antibiotic therapy, perioperative transfusion and American society of anaesthesiologist score of one (1). Mono microbial infection accounted for most of SSI at 84.8% with the commonest isolate being Escherichia coli (48.6%).Most of the poly microbial infections, were mainly two isolates(Escherichia coli and Klebsiella pneumonia, Escherichia coli and Proteus mirabilis, Streptococcus pyogenes and Candida albicans ). From the study there were no anaerobic isolates. Targeted public health education on harmful effects of alcohol consumption and cigarette smoking should be emphasised. There should be adherence to guidelines on use of blood and preoperative optimisation of patients. Periodic surveillance on SSI by surgical infection prevention committees in the general surgical units will result in reduction of SSI. Hospital based antibiotic stewardship programs should guide in use of antibiotics. Analytical studies looking at relationship between risk factors and SSI would result in identification of independent predictors of SSI in our set up.