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ASSESSMENT OF MICROBIAL CAUSE OF SURGICAL SITE INFECTION AMONG POSTOPERATIVE PATIENTS IN FEDERAL TEACHING HOSPITAL IDO EKITI

Abstract

This quantitative survey research aimed to investigate the perceptions of healthcare professionals at Federal Teaching Hospital Ido Ekiti regarding surgical site infections (SSIs). A structured questionnaire was designed and administered to a sample of 120 respondents, selected through a convenient sampling technique. The study adopted a rigorous quantitative survey research design to gather insights into the microbial causes, antibiotic susceptibility patterns, and associated risk factors of SSIs. The data collected were processed and analyzed using SPSS27, and the hypotheses formulated were tested through t-tests. The findings of the study revealed a significant association between specific microbial species and the occurrence of SSIs, emphasizing the importance of microbial factors in postoperative infections. Additionally, respondents perceived a significant difference in the antibiotic susceptibility patterns of microbial agents causing SSIs, highlighting the need for tailored antibiotic stewardship programs. Furthermore, the study indicated a statistically significant contribution of certain risk factors to the acquisition of microbial causes of SSIs among postoperative patients, underlining the significance of targeted preventive measures. In conclusion, this study contributes valuable insights into the perceptions of healthcare professionals regarding SSIs, emphasizing the roles of microbial factors, antibiotic susceptibility patterns, and risk variables. The results provide a foundation for evidence-based practices to enhance patient outcomes and improve the quality of postoperative care. Recommendations include strengthening microbial surveillance protocols, conducting regular antibiotic susceptibility studies, and implementing tailored antibiotic stewardship programs. While the study offers valuable contributions, it is essential to acknowledge the limitations, such as the use of a convenient sampling technique and the cross-sectional nature of the design. Future research should explore diverse perspectives, including those of patients, to further enrich the understanding of surgical site infections.

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CHAPTER ONE

INTRODUCTION

1.1       Background to the Study

Surgical site infections (SSIs) represent a significant and persistent challenge in the landscape of healthcare, exerting a considerable threat to patients undergoing surgical procedures. The issue is not isolated to specific healthcare institutions, and even Federal Teaching Hospital Ido Ekiti has grappled with the challenges associated with postoperative infections. This concern has prompted an urgent call for comprehensive research to delve into the microbial causes of SSIs, considering the substantial impact these infections can have on patient outcomes.

In a prospective cohort study conducted in a teaching hospital in Ghana, Bediako-Bowan et al. (2020) highlighted the importance of surveillance in understanding the landscape of surgical site infections. Their findings underscored the need for a thorough examination of the microbial factors contributing to SSIs, emphasizing the global nature of the problem. Similarly, Pantvaidya et al. (2022) conducted a propensity-matched analysis in patients undergoing major oncological surgery during the COVID-19 pandemic, shedding light on the intricate relationship between surgical procedures and infectious outcomes. This study emphasized the evolving dynamics of SSIs, particularly in the context of major surgeries during challenging circumstances.

Microorganisms, encompassing bacteria, viruses, and fungi, pervade the environment and can infiltrate surgical wounds, thereby posing a significant risk to patient recovery and well-being. Cappelli et al. (2022) provided unexpected insights from the COVID-19 pandemic, reporting on surgical site infections in patients undergoing breast oncological surgery during the lockdown. This study highlighted the unexpected challenges that the pandemic introduced, further emphasizing the need for a nuanced understanding of microbial causes in the development of SSIs.

The incidence and etiology of surgical site infections were explored in emergency postoperative patients in Mbarara regional referral hospital, South Western Uganda, by Lubega et al. (2021). Their findings illuminated the regional variations and specific challenges faced by emergency postoperative patients, contributing valuable insights to the broader understanding of SSIs. El-Saed et al. (2020) conducted a study in Saudi Arabia, emphasizing the high contribution and impact of resistant gram-negative pathogens causing surgical site infections. Their research highlighted the growing concern of antimicrobial resistance and its implications for postoperative infections.

Furthermore, investigations into the prevalence of specific microbial species causing SSIs have been conducted in various settings. El-Kholy et al. (2020) found a high prevalence of VIM, KPC, and NDM expression among surgical site infection pathogens in patients undergoing emergency surgery, shedding light on the spectrum of microbial agents responsible for postoperative infections. Collin et al. (2019) conducted a systematic review and meta-analysis on Group B Streptococcus in surgical site and non-invasive bacterial infections worldwide, underscoring the global relevance of specific microbial species in the context of SSIs.

In a more localized context, Singh et al. (2021) conducted research on the microorganisms isolated from postoperative wound infections among patients admitted to a hospital in Moradabad, India. This study emphasized the importance of understanding the local microbial landscape to tailor prevention and treatment strategies effectively.

Ethiopia, like many other regions, faces unique challenges in the realm of surgical site infections. Shakir et al. (2021) conducted a study in Harari Region Public Hospitals, Eastern Ethiopia, providing insights into the magnitude, bacterial etiologies, associated factors, and antimicrobial susceptibility patterns of isolates among postoperative patients. Legesse Laloto et al. (2023) further contributed to the understanding of SSIs in Ethiopia, presenting the incidence and predictors of surgical site infection in a prospective cohort study.

The occurrence of postoperative wound infections in Ayder Teaching and Referral Hospital, Mekelle, Ethiopia, was investigated by Mengesha et al. (2022). Their study focused on the aerobic bacteria in post-surgical wound infections and the patterns of their antimicrobial susceptibility, shedding light on the local microbial dynamics and antibiotic resistance patterns.

Mulu et al. (2022) examined postoperative nosocomial infections and antimicrobial resistance patterns of bacterial isolates among patients admitted at Felege Hiwot Referral Hospital, Bahirdar, Ethiopia. This study provided valuable insights into the prevalence of nosocomial infections and the antimicrobial resistance patterns of bacterial agents, essential for tailoring effective treatment strategies.

In a systematic review and meta-analysis, Birhanu and Endalamaw (2020) synthesized the available evidence on surgical site infection and pathogens in Ethiopia. Their comprehensive review highlighted the need for targeted interventions based on the prevalent microbial causes in the Ethiopian context.

The evolving nature of surgical site infections is evident in the context of the COVID-19 pandemic, as demonstrated by Collin et al. (2019), Pantvaidya et al. (2022), and Cappelli et al. (2022). These studies underscore the need for ongoing research to adapt prevention and treatment strategies in response to changing circumstances.

1.2       Statement of Problem

The prevalence of surgical site infections (SSIs) poses a significant problem within the healthcare landscape, affecting patients undergoing surgical procedures and challenging healthcare institutions, including Federal Teaching Hospital Ido Ekiti. Despite advances in surgical techniques and infection control measures, the persistent occurrence of SSIs necessitates a focused examination of the specific microbial causes and associated factors contributing to these infections.

The problem is underscored by the findings of Bediako-Bowan et al. (2020), who conducted a prospective cohort study in a teaching hospital in Ghana, revealing the ongoing challenges in surveillance and understanding the landscape of SSIs. Pantvaidya et al. (2022) further emphasized the evolving dynamics of SSIs, particularly in the context of major oncological surgeries during the COVID-19 pandemic, highlighting the need for adaptable strategies to address emerging challenges.

The unexpected lessons from the COVID-19 pandemic, as highlighted by Cappelli et al. (2022), indicated that the lockdown measures introduced unanticipated complexities in the context of surgical site infections, amplifying the urgency to identify and address the root causes. The study by Lubega et al. (2021) in emergency postoperative patients in Uganda draws attention to the specific challenges faced by this population, emphasizing the need for a nuanced understanding of risk factors and microbial causes.

Moreover, the high contribution and impact of resistant gram-negative pathogens causing SSIs, as noted by El-Saed et al. (2020), accentuate the alarming rise of antimicrobial resistance, adding another layer of complexity to the problem. The prevalence of specific microbial species, such as VIM, KPC, and NDM, as observed by El-Kholy et al. (2020), indicates the diverse spectrum of microbial agents responsible for SSIs, necessitating tailored intervention strategies.

In the local context of Ethiopia, studies by Shakir et al. (2021), Legesse Laloto et al. (2023), Mengesha et al. (2022), and Mulu et al. (2022) highlight the unique challenges faced by postoperative patients in the region, including the magnitude of infections, bacterial etiologies, associated factors, and antimicrobial resistance patterns. This diversity of findings underscores the complexity of the problem, requiring a multifaceted approach to address the specific challenges posed by SSIs in the Federal Teaching Hospital Ido Ekiti and similar healthcare settings.

1.3       Objectives of the Study

1. To identify the prevalent microbial species causing surgical site infections among postoperative patients in Federal Teaching Hospital Ido Ekiti.
2. To assess the antibiotic susceptibility patterns of the identified microbial agents responsible for surgical site infections.
3. To evaluate the risk factors associated with the acquisition of microbial causes of surgical site infections among postoperative patients.

1.4       Research Questions

1. What are the predominant microbial species responsible for surgical site infections among postoperative patients in Federal Teaching Hospital Ido Ekiti?
2. What is the antibiotic susceptibility pattern of the identified microbial agents causing surgical site infections?
3. What are the risk factors associated with the acquisition of microbial causes of surgical site infections among postoperative patients?

1.5       Research Hypotheses

Null Hypotheses(H₀):

1. There no significant association between specific microbial species and the occurrence of surgical site infections among postoperative patients.
2. The antibiotic susceptibility patterns of microbial agents causing surgical site infections do not differ significantly.
3. Certain risk factors do not contribute significantly to the acquisition of microbial causes of surgical site infections among postoperative patients.

Alternative Hypotheses(H₁):

1. There is a significant association between specific microbial species and the occurrence of surgical site infections among postoperative patients.
2. The antibiotic susceptibility patterns of microbial agents causing surgical site infections differ significantly.
3. Certain risk factors contribute significantly to the acquisition of microbial causes of surgical site infections among postoperative patients.

1.6       Significance of the Study

This research carries significant implications within the healthcare domain, particularly concerning surgical procedures and postoperative care. A comprehensive understanding of the microbial origins of surgical site infections (SSIs) is paramount for the formulation of precise preventive strategies and the development of effective treatment protocols. By shedding light on the specific microbial causes, this study is poised to make substantial contributions to the existing body of knowledge, serving as a guiding beacon for healthcare professionals in refining infection control strategies and elevating overall patient outcomes.

The knowledge generated through this research holds the potential to reshape the landscape of infection prevention and management. Healthcare professionals, armed with insights into the microbial intricacies behind SSIs, can tailor their approaches to better address the root causes of postoperative infections. This, in turn, facilitates the enhancement of existing infection control strategies, ensuring their alignment with the specific microbial challenges faced by patients in the surgical context.

Furthermore, the identification of prevalent microbial species and a detailed analysis of their antibiotic susceptibility patterns represent crucial facets of this study. These insights carry direct implications for treatment decisions, enabling healthcare practitioners to make informed choices regarding antimicrobial agents. The ability to select appropriate antibiotics based on the prevalent microbial landscape not only optimizes treatment outcomes but also plays a pivotal role in curbing the emergence of antibiotic-resistant strains. By tailoring treatments to the specific susceptibility patterns identified, healthcare professionals can contribute significantly to the global efforts aimed at mitigating the rise of antibiotic resistance, a growing concern in healthcare systems worldwide.