Risk Factors for Treatment-Resistant Postoperative Surgical Site Infections

Abstract

Objective:Surgical site infection(SSI) is the most common complication seen after surgery. The aim of this study was to determine the risk factors that cause resistance to antibiotic treatment for SSI. Methods:All patients’ records who underwent elective gynecologic surgery between 2021-2023 at the Department of Obstetrics and Gynecology, Kocaeli University were scanned. Patients who had positive surgical site culture were enrolled in the study. After antibiotic treatment, cultures were taken from all patients. The demographic, obstetric and perioperative characteristics were compared between culture negative(control group) and culture positive(study group) patients. Results:Patients with positive cultures were included in the study. There was a significant difference in terms of chronic medication between the two groups(p=0.002). The duration of hospitalization before SSI development was also significantly higher in the study group(p=0.017). A significant difference was found between the 2 groups in terms of the number of antibiotics used for the treatment of SSI(p=0.027). The use of multi-antibiotic regimens was more common in the study group. Conclusion:The use of oral antidiabetic drugs and prednisolone was higher and the duration of hospital stay was longer in patients that developed treatment-resistant SSI. The need for multi-antibiotic regimens based on initial culture results was more common in the study group. In order to reduce the incidence of treatment-resistant SSI in patients undergoing planned surgery, a throughout evaluation of the patient is essential. Clinicans should take into consideration the risk of treatment-resistant infection in SSI patients with chronic medication use, long hospital stay, and infections requiring multi-drug regimens.

Keywords

• gynecological surgery
• surgical site infection
• surgical site culture
• resistance to antibiotic therapy

Tedaviye Dirençli Postoperatif Cerrahi Alan Enfeksiyonlarında Risk Faktörleri

Öz

Amaç:Cerrahi alan enfeksiyonu(CAE) jinekolojik cerrahiler sonrası en sık görülen komplikasyondur. Bu çalışmadaki amacımız antibiyotik tedavisine dirençli CAE vakalarında dirence yol açabilecek risk faktörlerini belirlemektir. Materyal ve Metot:Kocaeli Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı tarafından Ocak 2021-Aralık 2023 yılları içinde jinekolojik nedenlerle elektif opere edilen tüm hastalar CAE varlığı açısından retrospektif olarak tarandı. Yara yeri enfeksiyonu bulguları gelişen ve kültür sonucunda üreme tespit edilen hastalar çalışmaya dahil edildi. Uygun antibiyoterapi sonrasında bu hastalardan kontrol kültürü alındı. Kültürde üreme olan hastalar (çalışma grubu) ile üreme olmayan (kontrol grubu) hastalar demografik, obstetrik ve perioperatif verileri karşılaştırıldı. Bulgular:Kültürde üreme olan 144 hasta çalışmaya dahil edildi. Sadece ilk kültürde üreme olan hasta sayısı 95(%66) iken her iki kültürde üreme olan hasta sayısı 49(%34) idi. Her 2 grup arasında kronik ilaç kullanımları açısından anlamlı fark vardı(p=0.002). CAE gelişimi öncesi yatış süresi de çalışma grubunda anlamlı olarak daha yüksekti(p=0.017). 2 grup arasında CAE tedavisinde kullanılan antibiyotik sayısı açısından anlamlı fark tespit edildi(p=0.027). Üç ve dört antibiyotik rejimlerinin kullanımının çalışma grubunda daha yaygın olduğu görüldü. Sonuç:Çalışmamızda tedaviye dirençli CAE gelişen grupta oral antidiyabetik ve prednizolon kullanımının daha fazla, hastanede yatış süresinin daha uzun olduğu tespit edilmiştir. Ayrıca tedaviye dirençli CAE grubunda ilk alınan kültür sonucuna göre çoklu antibiyotik tedavilerine daha fazla ihtiyaç olduğu izlendi. Planlı jinekolojik cerrahi yapılacak hastalarda tedaviye dirençli CAE sıklığını azaltmak için hastanın kapsamlı bir şekilde değerlendirilmesi esastır. Klinisyenler, kronik ilaç kullanımı, uzun süreli hastanede kalış ve çoklu antibiyotik tedavi rejimi gerektiren CAE hastalarında olası tedaviye dirençli enfeksiyon riskini göz önünde bulundurmalıdırlar.

Anahtar Kelimeler

• jinekolojik cerrahi
• cerrahi alan enfeksiyonu
• yara yeri kültürü
• antibiyoterapiye direnç

Kaynakça

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