Outcomes of surgical site infections in orthopedic trauma surgeries in developing countries: Need for baseline data and identification of risk factors
GM Shetty1, A Poojary2,
1 Department of Orthopedic Surgery, Asian Heart Institute and Research Centre, Mumbai, Maharashtra, India
2 Department of Microbiology, Breach Candy Hospital, Mumbai, Maharashtra, India
Dr. G M Shetty
Department of Orthopedic Surgery, Asian Heart Institute and Research Centre, Mumbai, Maharashtra
|How to cite this article:|
Shetty G M, Poojary A. Outcomes of surgical site infections in orthopedic trauma surgeries in developing countries: Need for baseline data and identification of risk factors.J Postgrad Med 2014;60:230-231
|How to cite this URL:|
Shetty G M, Poojary A. Outcomes of surgical site infections in orthopedic trauma surgeries in developing countries: Need for baseline data and identification of risk factors. J Postgrad Med [serial online] 2014 [cited 2020 Apr 9 ];60:230-231
Available from: http://www.jpgmonline.com/text.asp?2014/60/3/230/138707
Surgical site infections (SSIs) can significantly affect the outcome of any surgical procedure and add to the overall morbidity, mortality and treatment costs despite being uncommon. Risk and morbidity of SSIs in orthopedic cases is greater due to the presence of hardware or an implant at the surgical site. Most reports in the literature provide prevalence and outcome data from populations in "developed" nations and data is from India is meager or lacking.  The physicist Lord William Thomson Kelvin famously said "If you cannot measure it, you cannot improve it". Hence, India specific data on SSIs in orthopaedic trauma is required if we wish to significantly reduce its incidence and associated complications.
In this issue of the journal N Rajkumari and colleagues provide the much needed Indian data for SSIs in terms of prevalence and outcome for orthopedic trauma surgeries.  This prospective, observational study carried out at a level I trauma center in India over a 16-month period involved assessment of 852 orthopedic trauma patients for SSIs. Based on the new CDC reporting guidelines (2010), the prevalence of SSIs in orthopedic trauma patients was reported at 2.6% (after excluding cases with only cellulitis) and at 4.4% when cellulitis was included. Over 50% of patients developed SSI within 14 days of surgery, 12.5% of SSIs were diagnosed during follow-up after discharge and majority of the cases had superficial incisional SSI. The mean duration of hospital stay varied from 20 days for upper limb trauma and 37.5 days for lower limb trauma compared to 15 days in patients without SSIs. The investigators also reported Gram-negative bacteria such as Acinetobacter spp. as the predominant microorganism isolated by culture. This finding highlights the growing role of Gram-negative bacteria in implant-related surgical infections and is similar to the results of a study done in India by Fernandes and Dias  who reported that 20 % of their isolates in cases with infected prosthetic implants were Extended Spectrum Producing Beta Lactamases (ESBL) producing Gram-negative bacteria.
The study adds significantly to the literature on SSIs in orthopedic trauma patients from India. The finding that rate of SSIs at 2.6% in a level I trauma center in India is comparable to SSI rates from developed countries is indeed encouraging.  However, a major drawback of this study is the exclusion of patients with co-morbidities such as diabetes, hypertension and renal disease. It is well known that co-morbidities such as diabetes and renal disease, age and fracture or injury complexity can increase the risk of SSI. , Smoking, another well-known risk factor which can significantly affect SSIs rates and outcomes in a surgical patient, has not been taken into account in this study.  Furthermore, variables that may actually influence the SSI rate in orthopedic trauma patients has also not been studied and reported. This information is very important for the treating surgeon to identify patients at risk and where extra vigilance and care is required to prevent SSIs.
In summary, this study with its inherent limitations does provide useful baseline data regarding orthopedic trauma SSIs specific to one trauma centre in India. Replication at additional centers will add to the body of evidence and help develop preventative measures and treatment guidelines and policy.
|1||Rosenthal VD, Richtmann R, Singh S, Apisarnthanarak A, Kübler A, Viet-Hung N, et al.; International Nosocomial Infection Control Consortiuma. Surgical site infections, International Nosocomial Infection Control Consortium (INICC) report, data summary of 30 countries, 2005-2010.Infect Control Hosp Epidemiol 2013;34:597-604.|
|2||Rajkumari N, Gupta AK, Mathur P, Trikha V, Sharma V, Farooque K. et al. Outcomes of surgical site infections in orthopedic trauma surgeries in developing countries: Pitfalls in health care. J Postgrad Med 2014;60:254-9.|
|3||Fernandes A, Dias M.The microbiological profiles of infected prosthetic implants with an emphasis on the organisms which form biofilms.J Clin Diagn Res 2013;7:219-23.|
|4||Uçkay I, Hoffmeyer P, Lew D, Pittet D. Prevention of surgical site infection sinorthopaedic surgery and bonetrauma: State-of-the-art update. J Hosp Infect 2013;84:5-12.|
|5||Bachoura A, Guitton TG, Smith RM, Vrahas MS, Zurakowski D, Ring D. Infirmity and injury complexity are risk factors for surgical-site infection after operative fracture care. Clin Orthop Relat Res 2011;469:2621-30.|
|6||Scolaro A, Schenker ML, Yannascoli S, Baldwin K, Mehta S, Ahn J. Cigarette smoking increases complications following fracture: A systematic review. J Bone Joint Surg Am 2014;96:674-81.|