Surgical Site Infections and Prophylaxis Antibiotic Use in the Surgical Ward of Public Hospital in Western Ethiopia: A Hospital-Based Retrospective Cross-Sectional Study

Figures & data

Table 1 Socio-Demographic and Clinical Characteristics of the Study Participants (N = 281)

Variables	Categories	N (%)
Sex	Male	155 (55.2)
	Female	126 (44.8)
Age	≤20	28(10)
	21–40	131 (46.6)
	41–60	87 (31.0)
	≥61	35 (12.5)
Residence	Urban	147 (52.3)
	Rural	134 (47.7)
Presence of comorbid conditions	Yes	72 (25.6)
Types of surgery	Elective	150 (53.4)
	Emergency	131 (46.6)
Types of surgical procedures conducted	General surgery	110 (39.1)
	GI surgery	74 (26.3)
	Gynecologic surgery	41 (14.6)
	Urological surgery	33 (11.7)
	Orthopedic surgery	14 (5.0)
	Other surgery	9 (3.2)
Wound class	Clean	107 (38.1)
	Clean-contaminated	74 (26.3)
	Contaminated	66 (23.5)
	Dirty	34 (12.5)
Preoperative duration of hospitalization	≤1 day	208 (74.0)
	>1 day	73 (26.0)
Postoperative duration of hospitalization	1 day	9 (3.2)
	2 days	113 (40.2)
	3 days	128 (45.6)
	4 days	31(11)
Duration of surgery (in hours)	<1	85 (30.2)
	1–2	115 (40.9)
	>23	61 (21.7)
	>34	20 (7.1)

Note: Other surgery: neck surgery and appendectomy.

Abbreviation: GI, gastrointestinal.

Figure 1 Type of surgical site infection.

Table 2 Characteristics of Surgical Antimicrobial Prophylaxis Administration

Variables		Frequency (%)
Antibiotic surgical prophylaxis use	Yes	249 (88.6)
Timing of antibiotic prophylaxis Administration	30 minutes before surgery	100 (40.6)
	30 minutes to 1 hour before incision	108 (42.2)
	1–2 hours before incision	31 (13.2)
	Not known	10 (4.0)
Duration of SAP administration	Single dose	109 (43.8)
	24 hours	92 (36.9)
	48 hours	39 (15.7)
	72 hours	9 (3.6)
Indication of SAP	Indicated and administered	235 (94.4)
	Administered but not indicated	14 (5.4)
Choice of antibiotics prophylaxis	Appropriate	218 (92.8)
	Inappropriate	17 (7.2)
Dosage appropriateness	Appropriate	235 (94.4)
	Inappropriate	14 (5.4)
Route	Intravenous	203 (81.5)
	Intravenous and oral	35 (14.1)
	Oral	11 (4.4)

Abbreviation: SAP, surgical antibiotic prophylaxis.

Table 3 Pattern of Prophylactic Antibiotic Use in Surgical Patients

Prophylaxis Drug	Frequency (%)
Ceftriaxone	113 (45.4)
Ceftriaxone + metronidazole	83 (33.3)
Cloxacillin	32 (12.9)
Ceftriaxone + gentamicin + metronidazole	15 (6.0)
Ciprofloxacillin	6 (2.4)

Note: + Plus.

Table 4 Factors Associated with Surgical Site Infections Occurrence Among Surgical Patients

Variables	Categories	Status of SSI		Univariate Analysis	Multivariate Analysis
		No (N, %)	Yes (N, %)	COR (95% CI)	AOR (95% CI)	p-value
Sex	Male	128(82.6)	27(17.4)	1	1
	Female	98(77.8)	28 (22.2)	1.35(0.75–2.44)	7.23(0.27–13.6)	0.801
Age (in years)	≤20	25(89.3)	3(10.7)	1	1
	21–40	114 (87.0)	17(13.0)	1.24(0.34–4.57)	0.71(0.09–5.63)	0.749
	41–60	63(72.4)	24(27.6)	3.18(0.88–11.49)*	6.63(0.89–19.3)	0.065
	≥61	24(68.6)	11(31.4)	3.82(0.95–15.4)*	0.33(0.19–5.81)	0.450
Types of surgery	Elective	131(87.1)	19(12.9)	1	1
	Emergency	95(72.5)	36(27.5)	2.61(1.41–4.83)*	2.82(0.47–16.8)	0.254
Comorbidity status	Yes	38(52.8)	34(47.2)	8.01 (4.20–15.28)*	9.18(5.17–17.9)	<0.001
	No	188(90)	21(10)	1	1
Duration of surgery in hours	<1	75(88.2)	10(11.8)	1	1
	1–2	95(82.6)	20(17.4)	1.58(0.7–3.58)	0.85(0.12–6.10)	0.870
	>23	48(78.7)	13(21.3)	2.03(0.83–5.0)*	0.52(0.033–8.15)	0.640
	>34	8(40)	12 (60)	11.25(3.7–34.2)*	0.38(0.012–12.9)	0.803
Wound class	Clean	92(86)	15(14)	1	1
	Clean-contaminated	63(85.1)	11(14.9)	1.07(0.46–2.48)	1.94(0.145–15.8)	0.617
	Contaminated	49(74.2)	17(25.8)	2.13(0.98–4.62)*	6.01(1.77–16.8)	0.019
	Dirty	22 (64.7)	12 (35.3)	3.35(1.37–8.15)*	7.20(1.23–12.1)	0.029
Prophylactic antibiotics	Received	210(84.3)	39(15.7)	1	1
	Not received	16(50)	16(50)	5.39(2.49–11.66)*	6.63(1.89–19.3)	0.006
Timing of prophylaxis administration	30 minutes before surgery	88(88)	12(12)	1	1
	30 minutes to 1 hour before incision	98(90.7)	10(9.3)	0.8(0.32–1.97)	0.56(0.1–3.04)	0.499
	1 to 2 hours before incision	14(45.2)	17(54.8)	10.2(3.93–26.62)*	8.2(4.34–18.1)	0.001
	Not known	5 (50)	5 (50)	7.82(1.95–31.37)*	10.33(0.89–22.1)	0.062
Duration of SAP administration	Single dose	85(81)	24(19)	1	1
	24 hours	86(93.5)	6(6.5)	0.26(0.1–0.68)*	0.30(0.64–1.45)	0.136
	48 hours	29(74.4)	10(25.6)	1.22(0.52–2.86)*	7.20(1.23–28.17)	0.027
	72 hours	4 (44.4)	5 (55.6)	9.43(1.71–51.93)	5.89(0.43–12.28)	0.834

Note: *p<0.2.

Abbreviations: AOR, adjusted odds ratio; COR, crude odds ratio; SAP, surgical antimicrobial prophylaxis.