الفهرس 
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Abstract
Postoperative SSIs remain a major source of illness and a less frequent cause of death in the surgical patient. These infections number approximately 500,000 per year, among an estimated 27 million surgical procedures, and account for approximately one quarter of the estimated 2 million Nosocomial infections in the United States each year. Infections result in longer hospitalization and higher costs. The incidence of infection varies from surgeon to surgeon, from hospital to hospital, from one surgical procedure to another, and -most importantly- from one patient to another.
Surgical site infections (SSIs) are divided into incisional SSIs and organ/space SSIs. Incisional space SSIs are further classified as involving only the skin and subcutaneous tissue (superficial incisional SSIs) or involving deep soft tissues (e.g. fascial and muscle layers) of the incision (deep incisional SSIs). Organ/space SSIs involve any part of the anatomy (organs or spaces) other than the incision opened or manipulated during the operative procedure.
Wound healing is the body’s natural process of regenerating dermal and epidermal tissue. When an individual is wounded, a set of complex biochemical events takes place in a cascade to repair the damage. These events overlap in time and may be artificially categorized into separate steps: the inflammatory, proliferative, and remodeling phases.
The pathogens isolated from infections differ, primarily depending on the type of surgical procedure. In clean surgical procedures, Staphylococcus aureus from the exogenous environment or the patient’s skin flora is the usual cause of infection. In other categories of surgical procedures, including clean-contaminated, contaminated, and dirty, the polymicrobial aerobic and anaerobic flora closely resembling the normal endogenous microflora of the surgically resected organ are the most frequently isolated pathogens.
Disinfection and sterilization are essential for ensuring that medical and surgical instruments do not transmit infectious pathogens to patients. Because sterilization of all patient-care items is not necessary, health-care policies must identify, primarily on the basis of the items’ intended use, whether cleaning, disinfection, or sterilization is indicated.
Rapid covering and healing of both acute skin defects and chronic skin defects are important objectives for wound healing. The best way to heal a wound is to close it according to surgical standards as quickly as possible after injury.
The aim of this study is to investigate the risk factors for surgical site infection in abdominal surgery together with the identification of the etiological pathogens and their antimicrobial susceptibility.
A total of 150 patients enrolled in this study, their age ranged between 2 & 68 years old with mean of about 19 years old, about 71% of them are males. All patients were undergoing abdominal operations, 11% (17 patients) of them were emergency operations while 89% (133 patients) were elective operations.
In this study, surgical site infections occurred in 11 patients (out of 150) representing 7.3% of the whole study group. Frequencies of SSI according to type are 64% & 36%, classified as superficial & deep incisional, respectively. Wound swab culture was done for all infected cases.
In 36.4% of SSIs, Escherichia coli was the main bacterial species incriminated, Staphylococcus aureus accounted for 27.3% of SSIs. Pseudomonas each represented 18.2% of SSI isolates. While Enterococcus spp & Klebsiella each accounted for 9.1% .Whereas, gram-negative bacilli and gram-positive cocci were responsible for 74% and 36% of SSIs respectively.
Escherichia coli isolates are susceptible to Amikacin, Imipenem & Levofloxacin, while Linezolid was the first choice for Staphylococcus aureus; the two Pseudomonas aeruginosa isolates are susceptible to Imipenem. Enterococcus spp & Klebsiella pneumoniae are susceptible to Amoxicillin/Clavulanic Acid & Levofloxacin respectively.
Management instituted for SSI ranged from dressings only to surgical intervention. Management with dressing was adequate in 73% of cases (8 out of 11), while three cases needed surgical intervention.
The age group (>40 years) had the highest rates of SSI occurrence, 72.7% (8 out of 11) of overall SSI cases are above 40 years old, There was a statistically significant difference in rate of SSI between the age groups.
Out of 124 non-smoker patients 7 patients suffered from postoperative SSI, while out of 26 smoker patients only 4 patients develops SSI which make smoking not statistically significant difference in rate of SSI.
SSI was noted in 4 (out of 142) of non-diabetic patients and in 7 (out of 8) of diabetic patients, this makes statistically highly significant correlation between SSI rates & diabetes mellitus.
Obese patients appear to develop more SSI than overweight & normal weight patients respectively, as 8 Out of 11 (72.7%) patients with postoperative SSI were obese, which suggest statistically highly significant correlation between SSI rates & increased body weight.
All cases of the study are ASA score 1 & 2 only, 63% of all reported SSI cases are ASA score 2 which represent 7 cases out of a total of 19 cases labelled ASA score 2. This makes statistically highly significant correlation between SSI rates & ASA score.
In this study, 18 patients underwent emergency operation, 5 of them has the manifestations of postoperative SSI. The emergency operations showed a significantly higher rate of infection compared to elective operations.
The rate of SSI was higher in contaminated operations compared to clean contaminated and clean operations. There was 4 operations with contaminated wound, 3 of them (75%) developed postoperative SSI suggesting highly significant correlation between SSI rates & wound class.
The removal of hair preoperatively was undertaken in 10 patients (by shaving), 4 patients of them developed postoperative SSI. Statistically significant correlation between SSI rates & preoperative hair removal is suggested.
Out of 15 patients that their operations last more than 2 hours, only 4 patients noted with postoperative SSI. There was no significant difference in occurrence of postoperative wound infection between patients with prolonged surgery lasting two hours or longer and those who had shorter surgery time.
In 15 cases prosthetic implants was used as a part of the operation, only 3 patients returned with postoperative SSI. Use of implants has no statistically significant difference in SSI occurrence.
More than 90% (10 out of 11) of postoperative SSI cases got out of operating theatre with a drain suggesting highly significant correlation between SSI rates & drain usage.
All cases (100%) with absent SSI spent less than 3 days in the hospital post operatively, while there were 6 cases spent 3-10 days in the hospital & all of the had postoperative SSI. Again, the only 2 cases that stayed in the hospital more than 10 days were SSI cases. These results give highly significant correlation between SSI rates & postoperative hospital stay.