European Journal of Molecular & Clinical Medicine

Chronic orthopaedic infections are brought on by bacterial biofilms. Without adjuvant local antimicrobials, surgical debridement to remove biofilm may be inefficient because undiscovered biofilm pieces may stay in the site and reactivate the infection if left untreated. The levels and length of antibiotic exposure required to remove bacteria from clinical biofilms are still mostly unknown. For bacterial biofilms formed on bone and muscle in vitro, we calculated the minimal biofilm eradication concentration (MBEC) of tobramycin and vancomycin.
Method: CFU counts were used to characterizing the pathogen biofilms of S. aureus, S. epidermidis, E. faecalis, P. aeruginosa, and E. coli, which are commonly encountered in musculoskeletal illnesses. Serial log₂ dilutions (4000-31.25 µg/mL) of tobramycin, vancomycin or a 1:1 mixture of both medicines were applied to tissue specimens covered in biofilm for 5, 25, or 70 hours. To test bacterial survival after antibiotic exposure, tissues were subcultured. For each pathogen-antimicrobial-exposure-time combination, the MBEC was determined as the concentration at which there were no surviving bacteria.
Results: On tissue, all infections that were tested developed biofilm. Using MBEC on muscle or bone, tobramycin/vancomycin (1:1) was the most effective antibacterial treatment, often in the range of 200-750 µg/mL with 25 or 70hr exposure. For 53.2% of biofilms between 5 and 25 hours, 53.2% of biofilms between 25 and 70 hours, and for 76.6% of biofilms between 5 and 70 hours, MBEC decreased with exposure duration. In comparison to equivalent MBECs in muscle tissue, MBECs on bone were substantially greater (p <0.04). The majority of the time, tissue MBECs were lower than MBECs for the same pathogens on polystyrene tissue-culture plates that had previously been published.

The surgical site infection is defined as the occurrence of infection to the surgical site within 30 days of surgery if no prosthesis is placed and up to 12months if a prosthetic is implanted in the patients. The commonest risk factors of surgical site infection are, degree of contamination, patient’s own normal flora, organisms present in the hospital environment, preoperative preparation of surgical site, comorbidities etc. The present study was undertaken to evaluate the role of subcutaneous suction drain in reducing surgical site infections in emergency laparotomies.
Material and Methods: This prospective comparative study was conductedin Department of Surgery, GMC, Jammu over the period of 6 months and categorized a total of 100 patients in two groups, i.e. Group -A and Group- B. Group – A consist of 50 patients who had subcutaneous suction drain and Group-B consist of 50 patients, who didn’t receive subcutaneous suction drain.A detailed history was collected, physical examination and routine investigations were done and all the patients were followed up in post-operative phase. Data was tabulated, organized, analysed and interpreted in both descriptive and inferential statistics i.e., frequency and percentage distribution, by using statistical package for social science software (SPSS), version 22.0.
Results: In the present study, 16% patients in the drain group and 42% in the non-drain group developed infections. The hospital stay in the drain group was also relatively lower (5.23 ± 3.2 days) as compared to non-drain group i.e. 8.98±4.56 days. Further, the most common organism found was E. coli (78%) in Group-A and (80%) in Group-B respectively.
Conclusion: The findings of the present study revealed that the rate of surgical site infection (SSIs) was more in Group-B as compared to Group-A and the presence of SSIs increases the duration of hospital stay. It was concluded that the subcutaneous suction drains in emergency setting play significant role in reducing the incidence of surgical site infection.

Surgical site infection continues to be one of most common postoperative health care associated infections worldwide. SSIs are associated with significant morbidity and complications in the patient. Identifying an appropriate and effective modality of administration of antibiotics is need of the hour to minimize the SSIs. A prospective study was done among 100 patients who underwent elective and emergency surgeries in the department of General Surgery between October 2019 and June 2021 were included in the study. The patients were divided into 2 groups to receive cefotaxime either as intraincisional infiltration or intravenous route. The proportion of patients with signs of wound infection such as redness/warmth was significantly less with intraincisional infiltration than intravenous route (8% vs 26%). Presence of seroma was also significantly less with intraincisional infiltration (32% vs 51%). Thus, it is evident that intraincisional infiltration is more effective in preventing SSI than intravenous route.

 
Aim: The aim of this study was to examine whether a set of routine preoperative blood tests including WBCC, CRP, Creatinine (eGFR), albumin and hemoglobin predict the risk of SSI either alone or in combination.
Methods: The observational cohort study was designed to evaluate the optimal timing of surgical antimicrobial prophylaxis. The preoperative blood test parameters hemoglobin, creatinine, albumin, CRP and white blood cell count were collected in those patients considered to have an indication for preoperative blood testing as per clinical standards. A total of 200 patients were included in the analysis for the RCT and hence assessed for the availability of preoperative levels of the blood parameters of interest.
Results: A complete set of preoperative WBCC, CRP, albumin, creatinine and hemoglobin measurements was present for 48 of 100 patients (48%). The 100 patients with preoperative blood tests available were older, had higher ASA scores, had more secondary diagnoses, were more likely to be women. The 30-day SSI rate was higher in patients with preoperative blood work than in the group without (5.8% vs. 4.5%, p=0.044).
Conclusion: This study demonstrates strong associations between the levels of routine preoperative blood parameters and the risk of SSI. However, none of the blood parameters examined in this study showed striking predictive abilities in terms of surgical site infections and hence, the decision to postpone procedures to optimize patient factors that impact preoperative blood results cannot be generally recommended at a defined cut off.

Background: Healthcare-associated infections (HAI) are common worldwide and amongst one of them is wound infections which includes surgical site infections (SSI). Studies on unconventional methods of prevention of superficial wound infection, during emergency Lower Segment Caesarean Sections (LSCS)are relatively less in literature.
Aim: The study was conducted with the aim to determine the role of irrigation of subcutaneous tissue of wound with Normal Salineduring closure of emergency LSCS on reducing SSI and decreasing the morbidity

Introduction: Peritonitis is an inflammatory or suppurative response of the peritoneal lining to direct irritation. Surgical treatment for perforation peritonitis is highly demanding and very complex. The combination of improved surgical technique, antimicrobial therapy, and intensive care support has improved the outcome of such case. A scoring system which can compare patient populations and severity of illness, objectively to evaluate the treatment strategy is the required for evaluative research of intensive care. The present study was undertaken to evaluate the efficacy of Mannheim Peritonitis Index (MPI) score in patients with perforation peritonitis.
Materials and Methods: The present prospective study was carried among 50 patients ofperitonitis.  Using history, clinical examination and lab values risk factors found in MPI were classified according to values indicated and individual variable scores were added to establish MPI score. The cases were grouped into three: those below 21 points, between 21-29 points, and those above 29points. The data was analyzed, each variable in the MPI score along with other patient variables was analyzed using chi square analysis with various outcomes that were noted in the study. P value
Results: Around 80% of high risk group (MPI > 29) required more than 5 days of ICU stay. High risk group (MPI>29) has more complications than intermediate(MPI 21 TO 29) and low risk group.(MPI <21).Most common complication found in this study is Surgical site infection. Up to 60% patients with score >29 developed surgical site infection in post operative period which was about 42% in patients with score 21 -29 and about 19% in patients with score 29 and only one (7%) required inotropes with score 29. 40% patients with score >29 developed multi organ dysfunction. All the patients who developed MODS died. Thus, development of MODS post operatively is bad predictor of mortality.
Conclusion: Among the various variables of the scoring system duration of pain, organ failure on presentation and presence of feculent exudates these factorshad a significant hand in predicting the eventual outcome of thepatient.

Background: Chloromycetin ointment consists of 10 mg/g of chloramphenicol in plastibase 30W and soft white and liquid paraffin.Chloramphenicol has a broad spectrum of activity against Gram positive and Gram negative bacteria, rickettsias, and Chlamydia. Chloramphenicol ointment is indicated for treatment of bacterial conjunctivitis, but little evidence exists for its effectiveness in prophylaxis or treatment of wound infection. Despite this, it is regularly used in areas outside its main indication. Before our study, several of the investigating general practitioners had applied it to sutured wounds as prophylaxis against wound infection. A survey of UK plastic surgeons reported that 66% used chloramphenicol eye ointment in their practice, mainly as prophylaxis against infection. The ointment has been used as an adhesive for replacement of the nail bed.
Aim & Objective: 1.To study the efficacy of Chloramphenicol ophthalmic ointment as suture site prophylaxis.2.To study incidence of infections.
Methods: Hospital based Randomized Clinical trial. Study setting: Surgery Department of tertiary care centre. Study duration: April 2019 to April 2020. Study population: All patients who required “minor skin excision” from all body sites were eligible to participate in the study. Skin flaps and two layer procedures were recorded and included
Sample size:50
Results: Majority of study subjects belongs to age group 19-36 yrs contributing 40% followed by age group 37-54 yrs 18 cases (36%), age > 54 yrs 7 cases ( 14%) and age < 18 yrs 05 cases (10%) respectively. Mean age among intervention group is 36.04 with SD of 14.38 and mean age among Control group is 36.72 with SD of 14.18. Most of study participants were males contributing 27 cases (54%) and female contributing 23 cases (46%). Male:Female ratio is 1.17:  in intervention group majority cases presented with Lower extremities lesion e.g 8 followed by Trunk 7, Neck and face 6 and 4 cases with Upper extremities, in control group most of cases presented with Lower extremities lesion e.g 9 followed by Neck and face 7, Upper extremities 6 and 3 cases with Trunk lesion. Incidence of wound infections in intervention (chloramphenicol) and control (paraffin) groups Incidence of infection in intervention group was 8% and in Control group was 16%.

Background: Surgical site infections are among the most common hospital acquired
infections. They make upto 14-16% of inpatient infections. Objective of present study was to
evaluate the risk factors associated with surgical site infections in caesarian cases, the bacteria
causing wound infections in obstetric operations, the antibiotic sensitivity and resistance
pattern of the pathogens isolated.
Methods: 100 women with wound infection during hospital stay or within 30 days following
caesarean section were taken for the study. These case records were thoroughly studied and
noted. Pus samples were collected from the wound site with help of sterile swabs under
aseptic precautions and immediately transported to microbiology laboratory for culture and
sensitivity.
Results: Most of the patients belonged to the age group of 21-25 years, contributing to 55%
of the cases. Majority of the women are from rural areas (71%). 57% of the cases were
unbooked. 90% of the SSI were seen in emergency surgeries and 10% in elective surgeries.
Anaemia (48%) was the most common medical risk factor followed by hypertensive disorders
25%. The risk of post-operative infection has been found to be proportional to volume of
blood loss during cesarean section and duration of surgery. Staphylococcus aureus was found
to be predominant organism of wound infection of which 21% were MRSA followed by
Klebsiella and E. coli.
Conclusions: Proper assessment of risk factors that predispose to SSI is critical for the
development of strategies for reducing the incidence of SSI and for identifying high risk
patients requiring intensive postoperative surveillance. We can conclude that reduction in
intraoperative blood loss and duration of surgery can reduce the incidence of Postoperative
infections. Also Pre-operative antibiotics should not be made mandatory in all lower segment
caesarean section as no significant difference has been found in the infection rate in spite of
giving preoperative antibiotics.

Background: Appendicitis is the most common cause of acute abdominal pain,
requiring surgical intervention. The present study was conducted to assess efficacy of
postoperative antibiotics after appendectomy in non- perforated appendicitis.
Materials & Methods: 76 patients undergoing appendectomy of both genders were
divided into 2 groups of 38 each. Group I patients were not given any postoperative
antibiotics and the group II patients received a single dose of cefuroxime sodium and
metronidazole, 8 hours postoperatively. Open appendectomy was performed by the
standard operating technique through right lower quadrant incision. Parameters such
as duration of symptoms, duration of surgery and hospital stay was recorded.
Results: There were 26 males and 12 females in group I and 20 males and18 females in
group II. Duration of symptoms was 1.9 days in group I and 1.4 days in group II,
duration of surgery was 52.3 minutes in group I and 54.8 minutes in group II. The mean
hospital stay was 2.31 days in group I and 2.42 days in group II and surgical site
infections was 10 days in group I and 5 days in group II. The difference was significant
(P< 0.05).
Conclusion: Both groups were comparable in terms of surgical site infection.

Many methods have been evolved to combat wound infection during last century. Shortly
after the introduction of the first antimicrobial agent Penicillin alone was shown to reduce the
infection rate in abdominal surgery to 10% from a control rate of 25%.Initially, the antibiotics
were only used post-operatively for treatment of already established SSI. Later, the concept
of antibiotic prophylaxis was introduced. Many studies established the fact that preoperative
prophylaxis with antibiotics reduces wound infection. All patients were given spinal
anaesthesia all patients were painted with 10%povidone and recleaningwith spirit Surgical
field was drappedproperly and aseptic precautions followed group a: prophylaxis by
preoperative intraincisional infiltration of the antibiotic. One gram of cefotaxime diluted in 10
ml of distilled water will be infiltrated along the skin and the subcutaneous tissue in the
proposed line of incision, 20 minutes before surgical incision. In Group 1, wound discharge
was present in 1% on day 5. In group 2, wound discharge was present in 2% on day 5. There
was no significant difference in wound discharge between two groups. At other intervals
there was no discharge in both the groups.

Objective: To know about the various pathogens causing infection in orthopaedic implant surgeries and their antibiotic sensitivities.
Methods: This prospective study was conducted jointly in Departments of Orthpaedics and Trauma of Kausar Hospital, Afghan Hospital and Emergency Hospital, Kabul, from April 2019 to April 2020. All patients having close fractures of long bones including humerus, radius/ulna, femur and tibia requiring open reduction and internal fixation (ORIF) were included. Patients data was noted on a preformed proforma. Patients were followed up to 6 months.
Results: 30 patients out of 650 developed Surgical site infection were selected. 23 were male and 7 were female patients. Age range was from 5-75 years. Staphyloccus Aureus including Methicillin resistant Staphylococcus Aureus MRSA was most common cultured organism, followed by E Coli and pseudomonas. 23 cases yielded single organism, 5 cases yielded 2 organisms, 1 case yielded 3 organisms. There was no organism growth in one case.
Conclusion: Staphylococcus Aureus including MRSA is the main cause of surgical site infection in orthopedics implant surgery. Other bacteria like E.Coli may cause surgical site infection. Antibiotics should be prescribed according to culture and sensitivity reports.

The present prospective study has been carried out in the Department of General Surgery, KIMS Karad, out of 200 cases that had undergone other surgical procedures. The rate of infection of the surgical site and the frequency of various pathogens caused surgical site infection in general surgery units with their antibiotic resistance patterns. Aim of the study is to prevent or reduce the incidence of surgical site infection in clean, hygienic and contaminated cases.Surgical site infection (SSI) is both the most frequently studied healthcare-associated infection and the most common healthcare-associated infection. Incidence of General Surgical Site Infection is 5.5%. Older age group is commonly involved. Risk factors like anemia, diabetes mellitus, hypoproteinemia, and hypertension are associated with increased Surgical Site Infection rate. Contaminated cases had more SSI rate (23.33%) as compared to clean- contaminated cases (4.82%). Most of the bacterial isolates were multidrug resistant.