title: Incidence and factors associated with surgical site infections in a teaching hospital in Ujjain, India.
abstract: BACKGROUND
  Surgical site infections (SSI) are among the most commonly reported health care-associated infections; however, there is a paucity of data on SSI from India. This study aimed to determine the incidence of SSI and explore its associated factors at a teaching hospital in India.
  
  
  METHODS
  Direct and indirect surveillance methods, based on Centers for Disease Control and Prevention guidelines, were used to define SSI. Patients were followed up for 30 days postsurgery. Prescribing and resistance data were collected.
  
  
  RESULTS
  The SSI rate among the 720 patients investigated was 5%. Risk factors for SSI identified were as follows: severity of disease (P = .001), presence of drains (P = .020), history of previous hospitalization (P = .003), preoperative stay (P = .005), wound classification (P < .001), and surgical duration (P < .001). Independent risk factors identified included wound classification (odds ratio = 4.525; P < .001) and surgical duration (odds ratio = 2.554; P = .015). Most patients (99%) were prescribed antibiotics. Metronidazole (24.5%), ciprofloxacin (11%), and amikacin (9%) were the most commonly prescribed antibiotics. Most commonly isolated bacteria were Staphylococcus aureus (n = 14), of which 34% were methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa (n = 6), which showed resistance to ceftazidime (70%), ciprofloxacin (63%), and gentamicin (57%).
  
  
  CONCLUSIONS
  Incidence of SSI at the hospital was lower than reported in many low- and middle-income countries, although higher than reported in most high-income countries. Targeted implementation strategies to decrease incidence of preventable SSI are needed to further improve quality and safety of health care in this hospital and similar hospitals elsewhere.
authors.affiliation: Global Health/IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Paediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, India; Department of Women and Children's Health, International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden.
authors.forename: Ashish
authors.initials: A
authors.lastname: Pathak
authors.affiliation: Global Health/IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. Electronic address: erika.saliba@ki.se.
authors.forename: Erika A
authors.initials: EA
authors.lastname: Saliba
authors.affiliation: Department of Surgery, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, India.
authors.forename: Shailendra
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, India.
authors.forename: Vijay Kumar
authors.initials: VK
authors.lastname: Mahadik
authors.affiliation: Department of Microbiology, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, India.
authors.forename: Harshada
authors.initials: H
authors.lastname: Shah
authors.affiliation: Global Health/IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Cecilia Stålsby
authors.initials: CS
authors.lastname: Lundborg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D062665:Epidemiological Monitoring; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult
keywords: Antibiotics; Health care-associated infections; Pseudomonas aeruginosa; Risk factors; Rural; Staphylococcus aureus; Surveillance