Epidemiology of Surgical Site Infections: Incidence and Risk Factors at Jimma University Specialized and Comprehensive Hospital, Ethiopia

<b>Background</b>: Surgical site infections (SSIs) are healthcare-associated infections that can occur following surgical procedures, either at admission or within 30 days post-discharge. This study aimed to assess the incidence and associated risk factors for superficial SSI at a Tertiary Hospital in Ethiopia. <b>Methods</b>: A longitudinal study was conducted among patients undergoing surgery at Jimma University Specialized and Comprehensive Hospital (JUSCH) from 1 June to 30 September 2022. Pus, wound swab, or abscess samples were inoculated on Blood and MacConkey Agar for culture. Bacterial isolates were identified using MALDI-TOF, antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method, and the results were interpreted according to EUCAST 2022 breakpoints. Incidence rates, Kaplan-Meier analysis, extended Cox regression, and violin plots were utilized to analyze and present the findings. <b>Results</b>: Among 1205 participants, 629 (52.2%) were male, and the median age was 27 years (IQR: 16-40). The incidence of SSI was 9.2 per 1000 person-days. Most SSIs occurred during hospitalization (81.1%), and the remaining primarily developed within the first week post-discharge. The culture positivity rate was 72.7%, yielding 252 isolates comprising 36 bacterial species. The most frequently identified organisms were <i>E. coli</i> (22.2%), <i>Acinetobacter</i> (20.2%), and <i>Klebsiella</i> (14.7%). Over 67% of Gram-negative bacteria were ESBL producers. Age, gender, residence, hospital ward, surgery area, emergency surgery, longer hospitalization, and the number of staff attending the surgery were identified as important risk factors. <b>Conclusions</b>: This study revealed a high incidence of SSI during hospitalization, with significant proportion identified post-discharge. The high rates of multidrug-resistant Gram-negative pathogens underscore the urgent need for comprehensive infection prevention and control measures.