Pattern of superficial surgical site infection after elective orthopaedic surgery at Kikuyu P.C.E.A Orthopaedic Rehabilitation Center.

Abstract

Background: Surgical site infection (SSI) is the commonest complication of surgery with prevalence rates as high as 20% in the USA. 10 SSIs are a leading cause of morbidity and mortality as well as increase in economic implication to the patient Objective: The main objective of this study was to determine the local prevalence rates of SSIs and the common causative organisms isolated from the infected wounds with their antibiotic sensitivity. The data derived will be used to better the practice including designing protocols for antibiotic use as prophylaxis Design and setting: This was a prospective cohort study with the cohort being all patients undergoing elective orthopaedic surgery and was conducted at the P.C.E.A Kikuyu Orthopaedic Rehabilitation center. Methodology: 243 patients undergoing elective orthopaedic surgery and who consented to participation in the study were followed up for a period of 30 days from the day of surgery, initially in the ward then through specific clinic visits timed at 2 weeks and 30 days after surgery and the wounds were examined for features of infection using the Southampton Wound Scoring System; which is a wound scoring system designed to evaluate superficial surgical site infections, xii with wounds being categorized according to any complications and their extent. Wounds with features of infection were swabbed and sample taken for microscopy culture and sensitivity at the hospital labs. All patients were on prophylactic Ceftriaxone given pre-operatively and continued up to 3 days post operatively as standard for the hospital. Results: Out of the 243 patients 12 patients 4.9% (7 female and 5 male) developed SSI, 8 out of 144 patients (5.6%) that underwent open reduction internal fixation (ORIF) developed SSI, 3 out of 51 (5.8%) patients that underwent arthroplasty developed SSIs and 1 out of 38 that underwent soft tissue surgeries developed SSIs. There were no cases of SSIs in the group that had Arthroscopies. Out of the patients that developed SSI 4 patients were hypertensive, 5 patients diabetic, 1 patient with HIV infection and 2 patients had no known comorbidities. The commonest causative organism isolated from the infected wounds was Staphylococcus aureus except one in which Klebsiella spp was isolated. All the isolated Staphylococcus aureus were sensitive to Amoxicillin- clavulinic acid combination, cefuroxime and clindamycine. 3 out of 11 cultured Staphylococcus aureus showed resistance to ciprofloxacin.