Incidence, risk factors and outcomes of surgical site infections among patients admitted to Jimma Medical Center, South West Ethiopia: Prospective cohort study

Background: Surgical site infections are one of the leading health care-associated infections in developing countries. Despite improvements in surgical technique and the use of best infection prevention strategies, surgical site infections remained the major cause of hospital acquired infections. Therefore, this study aimed to determine incidence, risk factors, and outcomes of surgical site infections among patients admitted to Jimma Medical Center, South West Ethiopia. Methods: A hospital based prospective cohort study design was employed to follow adult patients admitted to general surgery ward, orthopaedic ward and gynaecologic/obstetrics ward of Jimma Medical Centre, from April 20 to August 20, 2019. All patients were followed daily before, during and after operation for 30 days to determine the incidence of surgical site infection and other outcomes. Data was entered using EpiData version 4.2 and analyzed using statistical software package for social science version 20.0. To identify the independent predictors of outcome, multiple stepwise backward cox regression analysis was done. Statistical significance was considered at p-value <0.05. Results: Of total of 251 participants included to the study, about 126 (50.2%) of them were females. The mean +/- SD age of patients was 38 +/- 16.30 years. Considerable number of patients 53(21.1%) developed surgical site infections. American Society of Anaesthesiologists score >= 3 [Adjusted Hazard Ratio (AHR) = 2.26; 95%CI = (1.03-4.93)], postoperative antibiotic prescription [AHR = 3.2; 95%CI = (1.71-6.01)], contaminated-wound [AHR = 7.9; 95%CI = (4.3-14.60)], emergency surgery [AHR = 2.8; 95% CI = (1.16-6.80)], duration of operation >= 2 h [AHR = 4; 95% CI = (2.17-7.50)] and comorbidity [AHR = 2.52; 95%CI = (1.28-4.94)] were independent predictors for surgical site infections. Twenty nine (11.6%) patients returned to operation room. The result of the multivariate cox regression analysis showed that SSI [AHR (95% CI) = 7(3.16-15.72)], and incision site [AHR (95% CI) = 2.5(1.14-5.42)] had statistically significant association with re-operation Conclusion: The incidence of surgical site infection was high in the study setting. There were significant numbers of contributing factors for the occurrence of surgical site infections. Although no mortality observed during the study period, significant number of patients re-operated. Large multicenter study is urgently needed to confirm the outcome of this study.

Automated summary

This study found a high incidence of surgical site infections among patients admitted to Jimma Medical Center, with significant predictors including American Society of Anaesthesiologists score >= 3, postoperative antibiotic prescription, contaminated-wound, emergency surgery, duration of operation >= 2 h, and comorbidity. This highlights the importance of infection prevention measures in reducing surgical site infections and the need for further research to confirm the findings.