Evaluation of Surgical Site Infections and Patterns of Microorganisms involved in Emergency Laparotomy in TUTH

Emergency laparotomy is a commonly performed operative procedure in emergency setting. Various factors like preoperative Haemoglobin, low BMI, Diabetes and duration of surgery increases incidence of Surgical Site Infection postoperatively. Surgical Site Infection can increase operative morbidity and length of hospital stay. This study was conducted to determine the rate of surgical site infection in emergency laparotomy and the microorganisms involved, their drug sensitivity and their association with preoperative and intraoperative conditions. The study is a prospective observational study which was conducted at the Department of General Surgery, Tribhuvan University Teaching Hospital, in N=179 patients (120 male patients and 59 female patients) undergoing emergency laparotomy from July 2022 to June 2023. Patients undergoing emergency laparotomy were enrolled and observed intraoperatively and during the postoperative period. Hemoglobin level < 11gm/dl and BMI < 18.5 was considered as low Hamoglobin and Underweight respectively. Duration of surgery and type of wound were noted intraoperatively. In postoperative period wound, SSI was noted and culture/sensitivity of wound/swab was observed. SSI and the microorganisms involved in SSI, drug sensitivity and its association with preoperative conditions like BMI, Haemoglobin, Diabetes and the duration of surgery were studied. Statistical analysis was performed with SPSS version 26, SSI was clinically diagnosed in 29 patients among 179 patients who underwent emergency laparotomy giving an incidence rate of 16.2%. Among SSI cases 21 (72.4%) were superficial SSI, while 7 (24.1%) were deep SSI and 1(3.4%) was Organ Space SSI. Identifiable Risk factors were contaminated and dirty wound, BMI <18.5, diabetes mellitus, anemia, and duration of surgery > 2 hrs. The mean age of the patients was 42.08 ±19 years. SSI was present in 6.5% of clean contaminated, 25% of contaminated and 23.2 % of dirty wounds. Patients with Anaemia, diabeties, underweight or exposed to increased duration of surgery are at risk of SSI. E.coli is the most common organism isolated at our center and sensitive to Levofloxacin in most cases.