title: A 4-year prospective study to determine the incidence and microbial etiology of surgical site infections at a private tertiary care hospital in Mumbai, India.
abstract: BACKGROUND
  There is limited single-center data on the incidence and microbial etiology of surgical site infections (SSIs) from developing countries.
  
  
  METHODS
  This is a prospective observational study over 4-year period (April 2009-March 2013) at a 750-bed private multispecialty hospital in Mumbai, India, among patients undergoing clean and clean-contaminated surgeries. Standard guidelines for preventing, classifying, and diagnosing SSI were followed.
  
  
  RESULTS
  A total of 24,355 patients underwent clean and clean-contaminated surgeries during the study period. The overall SSI rate was 1.6% (389 cases). The SSI rate in clean surgeries was 1.57%, and the SSI rate in clean-contaminated surgeries was 1.64%. Of the SSIs, 66% were caused by gram-negative bacilli (GNB) (Escherichia coli [22.9%], Klebsiella [18.2%], Pseudomonas [12.7%], and Acinetobacter [6.0%] were the top 4), 31.7% were caused by gram-positive bacilli (Staphylococcus: 70.5%, Enterococcus: 23.8%, Streptococcus: 1.8%), and 2.1% were caused by Candida. A total of 64% of the E coli and Klebsiella isolates were extended spectrum β-lactamase producing, 6% of the GNB were carbapenem resistant, and only 17.3% of S aureus isolates were methicillin resistant.
  
  
  CONCLUSIONS
  Although the SSI rate is comparable with established international benchmarks, increasing prevalence of antimicrobial resistance in GNB is a matter of serious concern.
authors.affiliation: Department of Infection Prevention and Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India.
authors.forename: Sweta
authors.initials: S
authors.lastname: Shah
authors.affiliation: Department of Infection Prevention and Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India. Electronic address: tanu.singhal@relianceada.com.
authors.forename: Tanu
authors.initials: T
authors.lastname: Singhal
authors.affiliation: Department of Infection Prevention and Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India.
authors.forename: Reshma
authors.initials: R
authors.lastname: Naik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D002175:Candida / Q000145:classification / Q000302:isolation & purification*; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D024881:Drug Resistance, Bacterial; D005260:Female; D016304:Hospitals, Private; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: Antimicrobial resistance; Etiology; India; Surgical site infections