Surgical Site Infections and Associated Risk Factors in Egyptian Orthopedic Patients

Background:Surgical site infections (SSIs) were identified on inpatient surgical wards, and most were associated with cardiac, abdominal, and orthopedic surgery. SSIs surveillance data are the foundation of effective infection control programs. Aim of the work:This study was conducted to estimate the risk factors and major pathogens involved in SSIs in orthopedic ward in a public hospital in Cairo, Egypt. Materials and Methods:During a 9-months period; a total of 93 consecutive orthopedic surgery patients were followed prospectively for 30 days after surgery. Risk factors for SSIs development were assessed for each patient. Swabs from infected surgical wounds were inoculated into routine culture media. Isolates were identified to the species level, and antimicrobial resistance patterns were determined. Results:The present study detected an overall SSIs rate of 25.8% (from 4.1% in clean wound to 66.7% in dirty contaminated wounds). Surveillance of risk factors of SSI, defined age, obesity (Body mass index "BMI" > 25), smoking, length of stay in hospital, class of wound, number of persons in the operating room, duration of operation and National Nosocomial infections surveillance (NNIS) index as independent risk factors for SSIs development. Microbiological study of infected surgical sites detected 47 pathogens. S. aureus was isolated most frequently 42.6%, Coagulase negative staphylococci "CoNS" and Enterococci were detected in 10.6% and 6.4% of isolates respectively. K. pneumonia, P. aeruginosa, K. oxytoca, E. coli and A. baumannii were detected in percentages of 14.9%, 10.6%, 4.3%, 4.3% and 2.1% of isolates respectively. Candida albicans was also detected in 4.3% of isolates. Antimicrobial susceptibility testing of isolates detected Oxacillin resistant S.aureus (ORSA) in 65% of S. aureus isolates. Enterococcus species resistance to vancomycin (VA) was 33.4%, and that to ampicillin (AMP) was 66.7%. Fluoroquinolones (FQs) resistance was detected in 20% of P. aeruginosa isolates. Extended-spectrum cephalosporin resistance (ESBLs) was detected in 50% of K. oxytoca isolates, 40% of P. aeruginosa and 28.6% of K. pneumonia isolates. Carbapenem resistance was detected only in K. pneumonia isolates (14.2%). Conclusion:We concluded that incidence of SSIs in orthopedic patients in Egypt is higher than that reported in some developing countries. S. aureus is the most common pathogens associated with orthopedic SSIs. ORSA, VA-resistant Enterococcus species, ESBLs producing Klebsiellae species and P. aeruginosa, as well as FQs resistant P. aeruginosa and carbapenem resistance K. pneumonia pose an ongoing and increasing challenge to the antimicrobial policy in our hospital. In orthopedic surgery unit risk factors for SSIs that may represent points of intervention including; limiting the number of personnel entering the operating room, improving NNIS risk index of patients and reduction of duration of surgery. In the era of restricted hospital budgets and increased bacterial resistance, longterm surveillance of SSIs rates and follow-up of compliance may provide a way to improve performance at low costs. [Journal of American Science 2010;6(7):272-280]. (ISSN: 1545-1003). Key words; Surgical site infections (SSIs); Risk factors of SSIs; S. aureus, Oxacillin resistant S. aureus (ORSA); Extended-spectrum cephalosporin resistance (ESBLs); Carbapenem resistance. 1-Introduction Surgical site infections (SSIs) were the most common procedure-associated Health care associated infections (HAIs) CDC(2007). SSIs were identified on inpatient surgical wards, and most were associated with cardiac, abdominal, orthopedic surgery and neurosurgery, Alicia et al.,(2008). SSIs increase morbidity and mortality and can bring considerable costs to an already overwhelmed health care system, Green and Wenzel(1977) and Taylor et al.,(1990) Antimicrobial-resistant pathogens that cause healthcare-associated infections (HAIs) pose an ongoing and increasing challenge to hospitals, both in the clinical treatment of patients and in the prevention of the cross-transmission of these problematic pathogens, Esposito and Leone( 2007); Schwaber and Carmeli (2007). Surveillance for SSI is a standard procedure in many hospitals, CDC(1996) has stated that United States has a countrywide surveillance system . Surgical site infection rates are an established measure of quality of clinical care,Wenzel(1985); Haley(1985), and reliable surveillance data are the foundation of effective infection control programs,CDC(1996). Unfortunately, Surveillance of SSIs is a persistent problem in orthopedic surgery, M'-Irrazi(2005). Despite the fact that, infection control program has been introduced to every hospital in Egypt few years ago, yet its implementation was questionable. In Egypt, Surveillance of SSIs -particularly in orthopedic surgeryhas not been well known and was thus investigated in this study aiming to define Journal of American Science 2010;6(7)