INCIDENCE OF SURGICAL WOUND INFECTION IN PATIENTS

RECEIVING PERIOPERATIVE ANTIBIOTICS

Dr. HIWA OMER AHMED MB.CHB.CABS.

consultant surgeon & lecturer in college of Medicine

University of Sulaimani

ABSTRACT

Most of the surgical wounds according to the type of the operations , are at risk
of contamination either from endogenous or exogenous sources . This contamination
is multifactorial , there are some well known methodes to decrease the rate of
contamination & concomitant wound infection . In this paper we tried to evaluate
the role of perioperative antibiotics in decreasing the rate of surgical wound
infection . And we found this regimn to be safe , costeffective and decreasing
wound infection , hospital stay , morbidity and mortality .

INTRODUCTION:

Large number of surgical patients will become infected before , during or after
the operations , either from endogenous flora of the gut , respiratory tract and
skin or from exogenous airborn dust which carries bacteria derived from skin
organism of attendants and operative personnels ( 1 ).

For any wound the most important priority is to avoid the development to infection
( 2 ).

The wound infection will increase morbidity , inpatient stay , cost and mortality
of the surgical patients , now it is clear that administering perioperative
antibiotics will decrease the incidence of wound infection ( 3 ) and it’s
concomitant complications by three folds ( 4 ) .
PAITIENTS & METHOD:

This paper is a prospective study from 1st March 1993 to 1st March 1997 , in
Sulaimani teaching hospital of 328 beds , including 500 patients who have
undergone different types of urgent and elective surgical operations . Four
hundred and twenty cases were elective and the rest were urgent .

All of them either underwent potentially contaminated (clear contaminated)

or contaminated operations as shown in table I .

Table : I showing number & percentage of the type of the operations

Type of the operations

Number
%

1. Clean contaminated

Like - cholecystectomy

- Hysterectomy.... etc

2. Contaminated like

- colectomy , gastrectomy

- cholecystectomy in presence of
infected bile ( 5 )

400

100
80

20

All the patients recieved perioperative antibiotics according to the policy now
the most widely adopted for 3 doses; first intravenously with the induction of the
anaesthesia , secound during the operation and third dose within 8 hours after the
operation.
We obliged in some cases, to continue same antibiotics, according to thier
pathological conditions, for 3 days postoperatively as shown in table II

Table II : showing number of doses & duration of the antibiotic courses :

Dose & duration

Nomber of patients
%

3 perioperative doses.

3 perioperative doses + for 3 days.

403

97

80.6

19.4

Antibiotics, which were used in our regimn shown in, table III

Table III: showing perioperative antibiotics

Antibiotics
Number of patients

Ampicillin + Gentamicin

Ampicillin + Gentamicin + Metronidasole.

360

140

The incidence of wound infection in the patients who recieved perioperative

antibiotics was 5.6% (28 patients), while in a control group of patients not
recieving perioperative antibiotics ((underwent same types of operations i.e.:
clean contaminated & contaminated) , the incidence of wound infection was 11.8%
(59 patients)
RESULTS & DISCUSSION:

The judicious use of perioperative prophlaxis reduces the infectious complications

of surgery, new study by National perinatal Epidemiology unit in oxford declared
that patients who recieved antibiotic prophylaxis has infection rates of about one
third of those in the untreated controls ( 6 ). Now it is clear that
perioperative antibiotic treatment significantly reduces the risk of postoperative
wound infection & is cost-effective.

It is quite clear that contamination in surgical wound is multifactorial & there

are some well known methodes to decrease rate of contamination, although
prophylactic antibiotics cann’t be substitud niether for sound surgical judgment (
7) , nor to strict aseptic technique , but it is one of the possible ways to
decrease the rate of infection & concomitant morbity and mortality .The main stay
of prophylaxis in surgery is the use of antibiotics( 8 ).

In this present work 500 patients were randomized to receive perioperative

antibiotics, 26 patients (5.2%) developed superficial localized infection of
subcutaneus tissues, 2 patients (0.4%) developed wound infection with burst at
abdomen the overall incidence of infected wounds was (56%) (28 patients). The
result of our patients compared with 500 patients, who had not recieved
antibiotics as perioperative regimn, 59 patients (11.8%) of them developed wound
infection, which means perioperative antibiotics had reduced rate of wound
infection by 2.1 folds, this effect of perioperative antibiotic is less than
current papers which is a bout 3 folds decrease.

The cause of this difference may be due to imperfect circumstances of our surgical
building & air changing, overcrowding of our theatres and lack of other factors
like preoperative bathing of the patients & shaving of the patients day before the
operation in elective cases in comparission to on table shaving of the skin when
is now more commonly applied in other centrer. Our results confirm the close
association between recieving perioperative antibiotics and lower rate of wound
infection .

We found the regimn safe, saving the time of medical & surgical staffs , reducing
Inpatient stay and decrease morbidity .

Using of perioperative antibiotics has economical benifit for the patient and the
hospital, first it will decrease inpatient stay & the patient & the family will
return to normal daily activities, second it will decrease concommitant cost of
drugs, dressing, visiting of inpatients and less beds will be occupied by patients
with wound infection.

Each inpatient with infection costs Sulaimani teaching hospital; 60 ID for three
meals 96ID for medical & paramedical staff work time in one day and costs of the
drugs, dressing and investigations, collectively each patient with infected wound
, costs the hospital 300 ID per day.
REFERRENCES:

1.a.j Harding raints , , Bailys & Loves short practice of surgery 20 th edition
,

London, 1988: 29.

2.Robin CN Williamson , Sacalt-An aid to Clinical Snrgrey - Churchill Living

stone - 6th edition - 1998 ; 57.

3.Eric W. Taylor , Infection in surgical wounds Oxford medical puplication ,

1992 , 210 , 244 .

4.P.W. HOWLE , Prophylactic antibiotics & caecarean section , BMJ , 1990- vol

300 page 2 .

5.Bruse E jarred , NMS Surgery , A Waverly company , 3rd edition , 1995 ; 30.

6.DC Rowe - Jones etal . Single dose cefotaxime plus metronidazole versus three

doses cefroxime plus metronidazol as prophylaxis.BMJ,1990 , vol 300 page 18 .

7.Schwartz etal , Principles of surgery 6th edition 1988-172

8.Richard L Hawkins, Treatment and Prognosis in Surgery, London, Third

Edition, 1994; 246.

‫نسبة إلتهاب مواضع العمليات الراحية ف الرضى الذين استلموا الضادات اليوية قبل‬

‫وأثناء وبعد العمليات الراحية‬

‫ هيوا عمر احد‬.‫د‬

‫البورد العرب ف الراحة العامة – جراح إستشارى –السليمانية ‪/‬العراق‬

‫إن أكثر مواضع العمليات الراحية ف السم بأنواعها الختلفة ‪ ،‬معرضة للتلوث‬

‫إما داخليا أو خارجيا ‪ .‬إن هذا التلوث متعدد العوامل ‪ ،‬و هناك نظريات معروفة لتقليل‬

‫نسبة التلوث ‪ .‬ف هذا البحث حاولنا تقيم دور الضادات اليوية إذا أعطيت قبل و أثناء و‬

‫هذة‬ ‫بعد العملية ف تقليل نسبة إلتهاب موضع العمليات الراحية ‪ .‬وتوصلنا ال النتيجة بأن‬

‫الطريقة سليمة و بدون مضاعفات و تقل من إلتهاب موضع الرح وتقلل من بقاء الريض ف‬

‫الستشفى و ف النتيجة تقلل نسبة الضاعفات والوفيات‬