Operating Site Infections at General Surgery Department of Gabriel Toure Training Hospital

Bakary Tientigui Dembélé^1,2, Alhassane Traoré^1,2, Adégné Togo^1,2, Lassana Kanté^1,2, Ibrahim Diakité², Bourama Diarra², Amadou Traoré², Madiassa Konaté², Boubacar Karembé², Yacaria Coulibaly^1,2, Mamby Keita^1,2, Souleymane Diallo^1,3, Souleymane Diallo^1,3, Gangaly Diallo^1,2

¹Faculty of Medicine and Odonto-Stomatology, Bamako, Mali.
²Department of General Surgery, CHU Gabriel Touré, Bamako, Mali.
³Department of Biology and Laboratory, CHU Gabriel Touré, Bamako, Mali.

DOI: 10.4236/ss.2015.62010                

Abstract

The operating site infections constitute the major postoperative issue in surgery. Our objectives were to determine the hospital frequency, the risk factors, the involved germs as well as the cost generated by the operating site infections. Method: Our three months prospective survey run from September the 1st to November the 30th 2013 has included all department patients being operated on and hospitalized. The criteria have been set by CDC d’Atlanta. Results: 374 files were involved, among them 229 (61.2%) were emergencies and 145 (38.8%) were scheduled. The average age was 41 (extremes 7 and 95 standard deviation 17.46), the sex ratio 1.67. The infective risk according to Altmeier has found 17.5% type 1, 25.1% type 2, 11.2% type 3 and 46.3% type 4; according to NNISS, 96 (25.7) were NNISS 0; 94 (51.9%) NNISS 1; 80 (21.4%) NNISS 2; and 4 (1.1%) NNISS. In the Altmeier class I have not got antibiotic before infection signs appearances. Our overall rate of operating site infections was 7.9% (29 cases), with 24 (82.8%) emergency cases. According to Altmeier’s class of infective risk, the rate of operating site infections was 1.54% making 1 out of 65 type I patients; 4.3% making 4 out of 93 type II patients; 11.9% making 5 out of 42 type III patients; 10.9% making 19 out of 174 type IV patients. According to NNISS, the infective risk has been assessed and was 2.08% for score 0, we have got 8.25% score 1, and 12.5% for score 2, and 25% for score 3. The bacteriology has been dominated by Escherichia colii(51.7), Proteus mirabilisi(13.8), and Klebsiella pneumoniaei(10.34). The germs have been resistant to the combination Amoxicillin-clavulanic Acid between 50% and 87% of cases. The most active antibiotics on the germs have been Cephalosporin, Polypeptides, and aminoglycosides. The hospital stay has been delayed to 12 days on average by operating site infections, making 2.5 times greater than those uninfected. The infection has increased the cost of management around 600 Euro.

Keywords

Infections, Operating Sites, Bamako

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Bone, R.C., Balk, R.A., Cerra, F.B., Delinger, R.P., Fein, A.M., Knaus, W.A., et al. (1992) Definition of Sepsis and Organ Failure and Guidelines for the Use of Innovatrice Therapies in Sepsis. Chest, 101, 1644-1655. http://dx.doi.org/10.1378/chest.101.6.1644
[2]	Paris-Nord, C. (1999) Le réseau INCISO trios mois de surveillance des infections du site opératoire dans 120 services de chirurgie de l’inter-region. Paris-nord. BEA, 25, 106-107 .
[3]	Pilly, E. (1992) Maladie Infectieuse. Annal de Chirurgie, 417, 310-319.
[4]	Chevalier, B., Saliou, C., Fall, R., Farthouat, P., Deconnink, J.P., et al. (2004) Surveillance des infections du site opératoire dans les services chirurgicaux de l’h?pital principal de Dakar. Xième Actualité du pharo, 66, 9-11.
[5]	Togo, A., Coulibaly, Y., Dembélé, B.T., Togo, B., et al. (2011) Risk Factors for Surgical Site Infection in Children at the Teaching Hospital Gabriel Touré, Bamako. Journal of Hospital Infection, 79, 371-372. http://dx.doi.org/10.1016/j.jhin.2011.08.007
[6]	Toure, L. (2004) Les infections du site opératoire dans le service de chirurgie générale et pédiatrique du CHU Gabriel Touré. Thèse de Médecine, Bamako, 57.
[7]	CDC Atlanta (1990) Les infections nosocomiales: Recommandations en matière d’enregistrement des infections nosocomiales. ATLANTA OP, 1-10.
[8]	Chadli, M., Rtabi, N., Alkandry, S., Koek, J.L., et al. (2005) Incidence des infections du site opératoire étude prospective à l’hopital militaire d’instruction Mohamed-V de Rabat, Maroc. Médecine et Maladies Infectieuses, 35, 218-222. http://dx.doi.org/10.1016/j.medmal.2005.03.007
[9]	Elizabeth, F. (2002) Infection Nosocomiale. Revue du Praticien, 10, 1-3.
[10]	Mekhail, N.A., Mathews, M., Nageeb, F., et al. (2007) Retrospective Review of 707 Cases of Spinal Cord Stimulation: Indication and Complications. Pain Practice, 11, 148-153. http://dx.doi.org/10.1111/j.1533-2500.2010.00407.x
[11]	LENOUVAILLE Enquête épidémiologique sur les infections postopératoires à l’.h?pital de Orthily. Thèse de médecine, Bordereau 1985, 7.
[12]	Astagneau, P. (2001) Infection du site opératoire; Réseau d’Alerte d’Investigation et de Surveillance des Infections Nosocomiales (RAISIN). Paris Journal of Hospital Infection, 48, 267-274.
[13]	CCLIN SUD-EST (2008) Conseil pour la prévention du risque infectieux. CCLIN Sud-Est, 4.
[14]	Medeiros, A.C., Aires-Neto, T., Azevedo, G.D., Vilar, M.J.P., Pinheiro, L.A.M. and Brand?o-Neto, J. (2005) Surgical Site Infection in a University Hospital in Northeast Brazil. Brazilian Journal of Infectious Diseases, 9, 310-314.
[15]	Jupeau-Vessieres, A.H. and Scavizzi, M.R. (1995) Maladies Infectieuses. Encyclopédie Médico-Chirurgicale, 3, 77-83.
[16]	Anagonous, S.Y., Makoutode, M. and Amassoubdji, B. (1994) Sensibilité des antibiotiques d’Escherichia coli en milieu hospitalier à propos de 1468 souches isolées au centre hospitalier et universitaire de cotonou. Médecine d'Afrique noire, 13, 8-10.
[17]	McGeer, A., Campbell, B., Emori, T.G., Hierholzer, W.J., Jackson, M.M., Nicolle, L.E., et al. (1991) Definitions of Infection for Surveillance in Long-Term Care Facilities. American Journal of Infection Control, 19, 1-7. http://dx.doi.org/10.1016/0196-6553(91)90154-5
[18]	Beytout, D. (1989) Ecologie Microbienne. In: Le Minor, L. and Veron, M., Eds., Bactériologie Médicale, Ellipses, Paris, 478-479.
[19]	Balagny, E. (1988) Surveillance générale, infimière-Anesthsit; D.A.R—H?pital Saint Antoine 184, rue du Fg St Antoine 6ème journée anesthésie réa, Paris, 23-40.
[20]	Lepoutre, A. (2001) Réseau d’Alerte d’Investigation et de surveillance des Infections Nosocomiales (RAISIN). Enquête nationale de prévalence, Institut de Veille Sanitaire, Saint-Maurice.
[21]	Fiorio, M., Marroni, M., Tristaino, B., Capitanucci, L., Serafini, S., De Socio, G. and Stagni, G. (2004) Nosocomial Infections in a General Surgical Ward. Recenti Progressi in Medicina, 95, 11-14.