Misha Gemedo, Chelkeba Legese, Melaku Tsegaye
Department of Pharmacy, Arsi University, Assella, Oromia, Ethiopia.
Department of Pharmacology and Therapeutics, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Ann Med Surg (Lond). 2021 Mar 29;65:102247. doi: 10.1016/j.amsu.2021.102247. eCollection 2021 May.
Surgical site infections are one of the leading health care-associated infections in developing countries. Despite improvements in surgical technique and the use of best infection prevention strategies, surgical site infections remained the major cause of hospital acquired infections. Therefore, this study aimed to determine incidence, risk factors, and outcomes of surgical site infections among patients admitted to Jimma Medical Center, South West Ethiopia.
A hospital based prospective cohort study design was employed to follow adult patients admitted to general surgery ward, orthopaedic ward and gynaecologic/obstetrics ward of Jimma Medical Centre, from April 20 to August 20, 2019. All patients were followed daily before, during and after operation for 30 days to determine the incidence of surgical site infection and other outcomes. Data was entered using EpiData version 4.2 and analyzed using statistical software package for social science version 20.0. To identify the independent predictors of outcome, multiple stepwise backward cox regression analysis was done. Statistical significance was considered at p-value <0.05.
Of total of 251 participants included to the study, about 126 (50.2%) of them were females. The mean ± SD age of patients was 38 ± 16.30 years. Considerable number of patients 53(21.1%) developed surgical site infections. American Society of Anaesthesiologists score ≥3 [ Adjusted Hazard Ratio (AHR) = 2.26; 95%CI = (1.03-4.93)], postoperative antibiotic prescription [AHR = 3.2; 95%CI = (1.71-6.01)], contaminated-wound [AHR = 7.9; 95%CI = (4.3-14.60)], emergency surgery [AHR = 2.8; 95% CI = (1.16-6.80)], duration of operation ≥ 2 h [AHR = 4; 95% CI = (2.17-7.50)] and comorbidity [AHR = 2.52; 95%CI = (1.28-4.94)] were independent predictors for surgical site infections. Twenty nine (11.6%) patients returned to operation room. The result of the multivariate cox regression analysis showed that SSI [AHR (95% CI) = 7(3.16-15.72)], and incision site [AHR (95% CI) = 2.5(1.14-5.42)] had statistically significant association with re-operation.
The incidence of surgical site infection was high in the study setting. There were significant numbers of contributing factors for the occurrence of surgical site infections. Although no mortality observed during the study period, significant number of patients re-operated. Large multicenter study is urgently needed to confirm the outcome of this study.
手术部位感染是发展中国家主要的医疗保健相关感染之一。尽管手术技术有所改进，且采用了最佳的感染预防策略，但手术部位感染仍是医院获得性感染的主要原因。因此，本研究旨在确定埃塞俄比亚西南部吉马医疗中心收治患者的手术部位感染发生率、危险因素及结局。
采用基于医院的前瞻性队列研究设计，对2019年4月20日至8月20日入住吉马医疗中心普通外科病房、骨科病房和妇产科病房的成年患者进行随访。对所有患者在手术前、手术期间和手术后30天进行每日随访，以确定手术部位感染的发生率和其他结局。数据使用EpiData 4.2版本录入，并使用社会科学统计软件包20.0进行分析。为确定结局的独立预测因素，进行了多步逐步向后Cox回归分析。p值<0.05时认为具有统计学意义。
纳入本研究的251名参与者中，约126名（50.2%）为女性。患者的平均年龄±标准差为38±16.30岁。相当数量的53名（21.1%）患者发生了手术部位感染。美国麻醉医师协会评分≥3[调整后风险比（AHR）=2.26；95%置信区间=（1.03 - 4.93）]、术后抗生素处方[AHR = 3.2；95%置信区间=（1.71 - 6.01）]、污染伤口[AHR = 7.9；95%置信区间=（4.3 - 14.60）]、急诊手术[AHR = 2.8；95%置信区间=（1.16 - 6.80）]、手术持续时间≥2小时[AHR = 4；95%置信区间=（2.17 - 7.50）]和合并症[AHR = 2.52；95%置信区间=（1.28 - 4.94）]是手术部位感染的独立预测因素。29名（11.6%）患者返回手术室。多变量Cox回归分析结果显示，手术部位感染[AHR（9
