514. A prospective study to determine the incidence and microbial etiology of surgical site infections at a private tertiary care hospital in Mumbai, India
Session: Poster Abstract Session: Surgical Site Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Poster Presenter_2.jpg (1.8 MB)
  • Background:

    There is limited data on the incidence and microbial etiology of surgical site infections (SSI) from developing countries.

     Methods:

    This is a prospective observational study over 12 months (January -December 2012) at a 750 bed private hospital in Mumbai, India in patients undergoing clean/ clean contaminated surgeries. Standard guidelines for preventing SSI were followed. The antimicrobial prophylaxis regimen was with cefuroxime with/without amikacin and metronidazole given within 60 minutes of the surgical incision and repeated if surgery lasted for more than 4 hrs. All patients were followed up for 30 days; SSI were diagnosed and classified as per standard CDC criteria.

    Results:

    A total of 7356 patients underwent clean/ clean contaminated surgeries during the study period. The overall compliance to hospital antibiotic policy was 90%. The overall SSI rate was 1.51% (111 cases). The SSI rate in clean surgeries was 1.37 % and in clean contaminated surgeries was 1.71%. SSI was associated with mortality in only one patient. Sixty percent of SSI’s were due to gram negative organisms (E coli 42%, Klebsiella 22%, Acinetobacter 17% and Pseudomonas 13% were the top four); 24% were due to gram positive (Staphylococcus 60%, Enterococcus 36% and Streptococcus 4%); 2% were due to fungi and there was no growth in 14%. 85% of the E coli and Klebsiella isolates were ESBL producing and 10% were carbapenem resistant; while 55% of acinetobacter and 20% of pseudomonas isolates were carbapenem resistant. All gram negative isolates were susceptible to colistin while only 70% of the acinetobacter isolates were susceptible to tigecycline. Only 1 of the 7 S. aureus isolates was methicillin resistant.

    Conclusion:

    Though the SSI rate is comparable to established benchmarks, the high prevalence of antimicrobial resistance in gram negative organisms is a matter of serious concern. These findings parallel the increasing contribution of multidrug resistant gram negative organisms in other hospital acquired infections such as ventilator associated pneumonia, catheter associated blood stream infections, urinary tract infections in developing countries.

    Tanu Singhal, MD, Infectious Disease and Pediatrics, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India, Sweta Shah, MD Microbiology, Microbiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, mumbai, India, Reshma Naik, GNM, MBA, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, mumbai, India and Shobha Kale, GNM, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India

    Disclosures:

    T. Singhal, None

    S. Shah, None

    R. Naik, None

    S. Kale, None

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