Surgical Site Infections: Risk Factors for Multiple Antibiotic Resistance in Abdominal Surgery

INTRODUCTION . Multidrug-resistant (MDR) organisms are increasingly becoming a major surgical site infection (SSI); however, the clinical outcomes and risk factors associated with resistant pathogens in general surgery remain poorly understood. THE AIM of the present research is to study the risk factors and consequences of infections in patients with SSI caused by antibiotic resistant pathogens with MDR. MATERIAL AND METHODS. A single-center, retrospective case-control study was carried out. The results of the examination and treatment of 50 patients with SSI + MDR, who made up the main group, and two control groups — non-MDR SSI and no SSI, 50 patients each, were analyzed. A total of 38 risk factors were used: pre- and surgical criteria, clinical, biochemical, instrumental data, postoperative complications and treatment features. The microbial landscape was studied in SSI+MDR. Single- and multivariate analysis was carried out, binary and multinomial logistic regression was performed. P-values <0.05 were considered significant at 95% CI. RESULTS. Significant risk factors were as follows: previous hospitalization, previous antibiotic therapy, terms of preoperative stay of the patient in the department, emergency surgery, class of surgery, decrease in the ratio of ALP/ ALPI, MEI and EMFC (p<0.01); elevated ASA score, obesity, low levels of plasma proteins and albumin, (p<0.05). Among the pathogens, there were more gram-negative enterobacteria (61%) than gram-positive ones (30.5%). Escherichia coli (36.3%) was the most commonly found bacterium, followed by Enterococcus faecium (9.09%), Morganella morganii (7.58%), Staphylococcus aureus (6%), and Pseudomonas aeruginosa (6%). In SSSI, Staphylococcus spp. prevailed. (>80%); in DSSI — Echerichia, Acinetobacter (>70%); and in OSSSI — Enterobacter spp., Acinetobacter and Citrobacter (>90%). SSI+MDR were characterized by serious surgical complications (Clavien Dindo Classification grade 3–5), wound dehiscences and OSSSI, reoperations (p<0.05). CONCLUSION. 1. The primary risk factors for multiple antibiotic resistance were as follows: previous hospitalization, previous antibiotic therapy, the duration of the patient’s preoperative stay in the department, emergency surgery, surgery class, reduced ALP/ALPI ratio, MEI and EMFC. In addition to the above, the following were also of great importance: increased ASA score, obesity, low plasma proteins, albumin. 2. When identifying risk factors for multiple antibiotic resistance in surgical patients, the development of severe postoperative complications, sepsis and multiple organ failure can be predicted. 3. Perioperative medical and preventive measures require a multidisciplinary approach involving the microbiologist, pharmacologist, immunologist, nutrition specialist, and other expert consultants.