Assessment of surgical site infections with antimicrobial resistance among cancer patients at a tertiary care hospital: A prospective study

<h2>ABSTRACT</h2><h3>Background</h3> Surgical site infections (SSIs) significantly challenge cancer patients' management, causing prolonged hospitalization, increased morbidity, and mortality. Antimicrobial resistance (AMR) complicates treatment and recovery. This study assessed the SSI incidence, antimicrobial sensitivity patterns, and clinical outcomes in cancer patients. <h3>Methods</h3> This prospective study enrolled 228 cancer patients over 9 months at Mahavir Cancer Sansthan and Research Center in Patna, Bihar, India, including patients of all ages who underwent surgery, developed SSIs, and received antimicrobial therapy. <h3>Results</h3> The study found an SSI incidence of 7.8%, highest in head and neck surgeries (16.6%). The average age was 46.77 years, with 50.9% males. Multidrug resistance was found in 48.01% of isolates, with <i>Pseudomonas aeruginosa, Escherichia coli,</i> and <i>Klebsiella oxytoca</i> as the main pathogens. High resistance to fluoroquinolones and third-generation cephalosporins was noted, while tetracycline and aminoglycosides were more effective. Mortality was significantly higher in patients with SSIs (33.9%) compared to those without SSIs (3.0%; p < 0.05). The highest mortality was observed in head and neck cancer surgeries (5.26%) and gallbladder surgeries (3.5%). Multivariate analysis identified carcinoma (OR = 5.36, 95% CI: 1.56–18.42, p=0.008) and history of radiation therapy (OR = 4.74, 95% CI: 1.13–19.76, p=0.033) as independent predictors of mortality. <h3>Conclusion</h3> This study reveals a high SSI incidence in cancer patients, with significant AMR. Multidrug-resistant pathogens and high mortality rates emphasize the urgent need for improved infection control and antimicrobial stewardship in cancer care. Limitations include the single-center design, potential biases from surgical practices, and antibiotic use variability.