ARE CHEAPER, OLD TIMERS ANTIBIOTICS STILL EFFECTIVE IN CONTROLLING POSTOPERATIVE WOUND INFECTIONS IN A PUBLIC SECTOR HOSPITAL?

ABSTRACT

Aims: To identify the common bacterial pathogens involved in post operative wound infections and determine their sensitivity patterns.

Settings: Surgical ward of Jinnah post Graduate Medical Centre, Karachi.

Methods: This was a 1-year cross sectional study, where data was collected from all patients who underwent surgery in a surgical ward of JPMC. Culture and sensitivity was performed only for patients who developed infection according to CDC definition. Data was collected on pre-designed performa which included details about patient’s demographics, type of surgery, prophylactic antibiotic, any co-morbids, wound infection and results of culture and sensitivity testing. Association of postoperative wound infections with different variables was also studied.

Results: Total 1120 surgical procedures were performed in the selected ward during the study period, of which 82 (7.3%) patients developed postoperative wound infection.  Age of patient, electivity of procedure, wound class and diabetes were found to be main contributing factors to postoperative wound infections. Frequency of infection in clean, clean contaminated, contaminated and dirty procedures was 1.5%, 2.5%, 6.5% and 21.4% respectively. Pathogens were isolated in 52 (73.2%) patients. The most commonly isolated pathogens were E.coli (33.8%), Ps. aeruginosa (16.9%) and S. aureus (15.5%). All the E.coli isolates showed 100%, 93%, 32% and 12 % resistance to Ceftriaxone, Ofloxacin, Amikacin and Meropenem respectively. Pseudomonas aeruginosa isolates were 100% resistant to Tetracyclin and Ceftazidime, 91.6% to Ofloxacin, 83.3% to Meropenem and 66.7% to Amikacin.  S. aureus exhibited maximum resistance to Cloxacillin(100%) followed by Ofloxacin(90.9%),  Tetracyclin(45.5%), Amikacin (45.5%), Chloromphenicol (36.4%) and Vancomycin (0%).

Conclusion: Frequency of postoperative wound infections is high in the surgical ward. The situation is further worsened by increasing frequency of multi-drug resistant (MDR) organisms along with resistance against older and currently used antibiotics.