Bacteriology of Gynaecological Surgical Site infection in a Medical University Hospital
OBJECTIVE : To study post surgical infections and sensitivity of the isolates so that recommendations can be made for their prevention and empirical antibiotic treatment in obstetric and gynaecological operations.
METHODOLOGY : This was cross – sectional study which was conducted among patients with post – operative wound infections in three wards of obstetric and gynaecology in teaching hospital of Nishtar Medical University from June 2014 to June 2016. Five hundred swabs / pus specimens from various types of surgical sites suspected to be infected on clinical grounds were processed by standard method and antibiotic susceptibility testing of all isolates was done using Modified Kirby Baur disc diffusion technique. The data was analysed using SPSS 17.0 and all statistical significance was established by using chi – square test. P <0.05 was chosen for overall statistical significance. Sample selection criteria was according to non – probability sampling.
RESULTS : Out of 500 swabs there was no growth on 149 (29.8%) after 24 hours. The most common pathogen was Escherichia Coli 141 (28.2%), followed by Staphylococcus Aureus 121 (24.2%), Staphylococcus Epidermitis 40 (8.0%), Pseudomonas Aeruginosa 21 (4.2%), Enterococcus Faecalis 2 (0.4%). Most of the gram negative bacilli and gram positive cocci were resistant to routine prophylactic antibiotics. Ciprofloxacin used as prophylactic antibiotic, sensitive to only 66 isolates but Amikacin, Imipenem, and Vancomycin were sensitive to 126,281 and 161 isolates respectively. These antibiotics are very expensive and out of reach of poor people.
CONCLUSION : SSI represents a significant source of post – operative morbidity for gynaecological surgery patients. Gynaecologic surgery, particularly hysterectomies, exposes the surgical site to a variety of endogenous bacteria unique to our specialty. To prevent these happenings there is urgent need to adopt basic principles of asepsis and sterilization and to make judicious use of prophylactic and therapeutic antibiotics