Jun Leong, Wong
(2015)
Surgical site infections among patients underwent clen and clean-contaminated surgery in Hospital Universiti Sains Malaysia : risk factors, microbiological and staphylococcus aureus molecular profile.
Masters thesis, Universiti Sains Malaysia.
Abstract
Surgical site infections (SSI) are among the most commonly encountered
healthcare associated infection. The incidence were closely been monitored as it
is associated with considerable morbidity and mortality. The common aetiological
agents responsible for the infection include Staphylococcus aureus,
Streptococcus spp, Enterococcus spp, and Pseudomonas aeruginosa. The
identification of the causative agents as well as their antimicrobial sensitivity
pattern helps in the treatment plan. Therefore the aims of this study were to
determine the incidence and risk factors of SSI as well as to identify the causative
microorganisms and their sensitivity profile.
This prospective cohort study was conducted from June 2013 until July
2014 at Hospital Universiti Sains Malaysia. Seventy-two patients underwent
clean and clean-contaminated surgeries were consented preoperatively and
strictly followed up for any signs of SSI for duration of 30 days post operation.
Nasal screening for Staphylococcus aureus and Methicillin-resistance
Staphylococcus aureus was carried out preoperatively. Tissue samples or wound
swab from infected patients were taken for microbial identification and its
sensitivity pattern. Staphylococcus aureus strain isolated were proceed to
polymerase chain reaction analysis to detect the virulence genes (TSST, PVL,
cna, hlg, icaA, and SdrE).
The overall incidence rate of SSI was 18.1% specifically for clean and
clean-contaminated surgeries are 20% and 11.8%, respectively. Significant risk
associated with SSI by simple logistic regression analysis included patients
admitted two days or more prior to surgery (OR 12.67; 95% CI, 2.02 to 79.53),
underwent CABG surgery (OR 10.20; 95% CI, 2.66 to 39.08), underlying
diseases (OR 9.46; 95% CI, 1.15 to 77.50), history of diabetes mellitus (DM) prior
to the surgery (OR 9.40; 95% CI, 2.36 to 37.39), total hospitalization period more
than seven days (OR 7.84; 95% CI, 2.12 to 29.0), duration of surgery more than
four hours (OR 7.08; 95% CI, 1.84 to 27.27), and discharged home three days or
longer after surgery (OR 5.13; 95% CI, 1.39 to 18.84).
Multiple logistic regression method demonstrated that the patients who
have history of DM (OR 6.97; 95% CI, 1.49 to 32.71) and underwent CABG
surgery (OR 5.54; 95% CI, 1.22 to 25.03) had significant risks of SSI. Gram
negative microorganism was the leading causative microorganism and in
Staphylococcus aureus strains, icaA gene was the most common virulence gene
detected.
In conclusion, SSI among clean and clean-contaminated surgeries are
high in our setting. DM and patients underwent CABG operation are at high risk
to get SSI. Gram negative microorganisms are common as compare to Gram
positive, however they are all sensitive strains.
Actions (login required)
 |
View Item |
![[img]](http://eprints.usm.my/style/images/fileicons/application_pdf.png)
