Incidence, Risk Factors, Antimicrobial Susceptibility Patterns and Outcomes of Surgical Site Infections among Patients Admitted to Jimma Medical Center, South West Ethiopia: Prospective Cohort Study

Abstract

Background; Surgical site infections are one of the leading health care–associated infection in developing countries. Despite improvements in surgical technique and the use of best infection prevention strategies, surgical site infections remained the major cause of hospital acquired infections. Objective: To assess the incidence, risk factors, antimicrobial susceptibility patterns and outcomes of surgical site infections among patients admitted to Jimma Medical Center, South West Ethiopia. Methods: A prospective cohort study involving 251 patients that underwent surgical procedure at general, orthopedic and gynecologic/obstetrics wards of Jimma Medical Center from April 20 to August 20, 2019 was conducted. All patients were followed daily before, during and after operation for 30 days starting from the date of operation. Data was entered using EpiData version 4.2 and analyzed using statistical software package, SPSS version 20.0. To identify the independent predictors of outcome, multiple stepwise backward cox regression analysis was done. Statistical significance was considered at p-value <0.05. Patient’s written informed consent was obtained after explaining the purpose of the study. Patients were informed about confidentiality of the information obtained. Results: Of total of 251 participants included into study, about 126 (50.2%) were females. The mean± SD age of patients was 38 ±16.30 years. Considerable number of patients 53(21.1%) developed surgical site infections. ASA score ≥3 [AHR=2.26; 95%CI=(1.03- 4.93)], postoperative antibiotic prescription [AHR=3.2; 95%CI= (1.71-6.01)],contaminated- wound [AHR=7.9; 95%CI=(4.3-14.60)],emergency surgery [AHR=2.8; 95% CI= (1.16- 6.80)], duration of operation ≥ 2 hours [AHR=4; 95% CI=(2.17-7.50)] and comorbidity [AHR=2.52; 95%CI=( (1.28-4.94)] were independent predictors for surgical site infections. E.coli was the most frequent pathogen associated with surgical site infections and multi drug resistance was seen in most of the isolates. Conclusion: The incidence of surgical site infection was high in the study setting. There were significant numbers of contributing factors for the occurrence of surgical site infections. Multi drug resistance was seen in most of the isolates. Early identification of patients at risk and rational antimicrobial use is necessary to reduce burden of surgical site infections and multidrug resistance pathogens