Superficial Surgical Site Infection after Primary Closure Versus Delayed Primary Closure of Wound in Perforated Appendicitis

Authors

  • Yabinda Sahrish
  • Zainab Abdullah Kaludi
  • Shamaila Ayub
  • Khurram Zia
  • Muhammad Athar Khan
  • Nadia Khalid

DOI:

https://doi.org/10.51985/JBUMDC2019126

Abstract

Objective: To assess the superficial surgical site infection after primary closure versus delayed primary closure of wound
in perforated appendicitis.
Study Design and Setting: This was an observational study conducted at Darul Sehat Hospital & Civil Hospital Karachi
during March 2019 to August 2019
Methodology: All patients of either gender between 18-50 years of age undergoing open Appendectomy through standard
gridiron incision in emergency having consented for participation in the study prior to surgery and with per-operative
finding of perforated appendix in emergency were included. Patients on steroids or immunosuppressive agents, smoker
staking 5 or more cigarettes per day, patients with history of Diabetes Mellitus, chronic liver disease and chronic renal
failure were excluded from the study. Patients with perforated appendix were randomly allocated into two Groups. Group
A received delayed primary closure at 3rd post-operative day while in Group B primary closure was done immediately after
appendectomy. All patients were examined for signs and symptoms of superficial surgical site infection at the 5th postoperative
day before discharge from the hospital. SPSS version 13 was used for data analysis. Chi square test was applied
to compare the outcome (superficial surgical site infection) in both groups. P-value <0.05 was considered as significant.
Results: A total sixty patients were allocated in each group. Wound infection was very high among patients with immediate
closure (40%) as compared to group which received delayed primary closure (15%) (p=0.020).
Conclusion: The superficial surgical site infection was significantly higher after primary closure versus delayed primary
closure of wound in perforated appendicitis.

References

and threats. Pharmacy and therapeutics. 2015; 40(4):277.

Chang HH, Cohen T, Grad YH, Hanage WP, O'Brien TF, Lipsitch M. Origin and proliferation of multiple-drug resistance in bacterial pathogens. Microbiol. Mol. Biol. Rev.. 2015;79(1):101-16.

World Health Organization. Implementation manual to prevent and control the spread of carbapenem-resistant organisms at the national and health care facility level: interim practical manual supporting implementation of the Guidelines for the prevention and control of carbapenem-resistant Enterobacteria- ceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities. World Health Organization; 2019.

Zanganeh Z, Eftekhar F. Correlation of oxacillinase gene carriage with the genetic fingerprints of imipenem-resistant clinical isolates of Acinetobacter baumannii. JJM. 2015 8(9).

Codjoe FS, Donkor ES. Carbapenem resistance: a rev. Med Sci. 2018; 6(1):1.

Aktaº Z, Kayacan ÇB, Schneider I, Can B, Midilli K, Bauernfeind A. Carbapenem-hydrolyzing oxacillinase, OXA- 48, persists in Klebsiellapneumoniae in Istanbul, Turkey. Chemotherapy. 2008; 54(2):101-6.

Kazi M, Khot R, Shetty A, Rodrigues C. Rapid detection of the commonly encountered carbapenemases (New Delhi metallo- -lactamase, OXA-48/181) directly from various clinical samples using multiplex real-time polymerase chain reaction assay. IJMS. 2018 1;36(3):369.

Mohanty S, Maurya V, Gaind R, Deb M. Phenotypic characterization and colistin susceptibilities of carbapenem- resistant of Pseudomonas aeruginosa and Acinetobacter spp. The Journal of Infection in Developing Countries. 2013; 7(11):880-7.

Guo L, An J, Ma Y, Ye L, Luo Y, Tao C, Yang J. Nosocomial outbreak of OXA-48-producing Klebsiellapneumoniae in a Chinese hospital: clonal transmission of ST147 and ST383. PLoS One. 2016; 11(8):e0160754.

Moghadampour M, Rezaei A, Faghri J. The emergence of bla OXA-48 and bla NDM among ESBL-producing Klebsiellapneumoniae in clinical isolates of a tertiary hospital in Iran. ActamicrobiologicaetimmunologicaHungarica. 2018; 65(3):335-44.

Khatun R, Shamsuzzaman SM. Detection of OXA-181/OXA-

carbapenemase producing Enterobacteriaceae in Bangladesh. Ibrahim Medical College Journal. 2015;9(2):45- 51.

Bakthavatchalam YD, Anandan S, Veeraraghavan B. Laboratory detection and clinical implication of oxacillinase- 48 like carbapenemase: the hidden threat. Journal of global infectious diseases. 2016; 8(1):41.

Golle A, Janezic S, Rupnik M. Low overlap between carbapenem resistant Pseudomonas aeruginosa genotypes isolated from hospitalized patients and wastewater treatment plants. PloS one. 2017; 12(10):e0186736.

Al-Ahmadi GJ, Roodsari RZ. Fast and specific detection of Pseudomonas Aeruginosa from other pseudomonas species by PCR. Annals of burns and fire disasters. 2016 31; 29(4):264.

Wenzler E. Feature Article Applying Fluoroquinolone Pharmacokinetics, Pharmacodynamics, and Updated Clinical Breakpoints for Gram-Negative Pathogens to Determine Optimal Dosing. CLSI AST News Update.4 2019.

Song W, Hong SG, Yong D, Jeong SH, Kim HS, et al. Combined use of the modified hodge test and carbapenemase inhibition test for detection of carbapenemase-producing Enterobacteriaceae and metallo- -lactamase-producing Pseudomonas spp. Annals of laboratory medicine. 2015; 35(2):212-9.

Walthall K, Anderson K, Reese N, Lonsway D, KamileRasheed J, Karlsson M. Evaluation of the RAPIDEC CARBA NP, Conventional CarbaNP, and the Modified Carbapenem Inactivation Method (mCIM) Tests for Phenotypic Detection of Carbapenemase-Producing Organisms. American Journal of Clinical Pathology. 2018; 150(suppl_1):S123-4.

Shaista Bakhat, Yasmeen Taj, Faisal Hanif, Saman Nadeem

Judd WR, Ratliff PD, Hickson RP, Stephens DM, Kennedy CA. Clinical and economic impact of meropenem resistance in Pseudomonas aeruginosa–infected patients. American journal of infection control. 2016; 44(11):1275-9.

Buehrle DJ, Shields RK, Clarke LG, et al. Carbapenem- resistant Pseudomonas aeruginosa bacteremia: risk factors for mortality and microbiologic treatment failure. Antimicrob agents and chemother. 2017; 61(1):e01243-16.

Abbas SH, Naeem M, Adil M, Naz SM, Khan A, Khan MU. Sensitivity patterns of Pseudomonas aeruginosa isolates obtained from clinical specimens in Peshawar. Journal of Ayub Medical College Abbottabad. 2015 ;27(2):329-32.

Pierce VM, Simner PJ, Lonsway DR, Roe-Carpenter DE, Johnson JK, Brasso WB, et al. Modified carbapenem inactivation method for phenotypic detection of carbapenemase production among Enterobacteriaceae. Journal of clinical microbiology. 2017; 55(8):2321-33.

Sfeir MM, Satlin MJ, Fauntleroy KA, et al. Blood-Modified Carbapenem Inactivation Method (Blood-mCIM): a Phenotypic Method for Detecting Carbapenemase-Producing Enterobacteriaceae Directly from Positive Blood Culture Broths. Journal of clinic microb. 2019.

Pawar S, Mohite ST, Datkhile K, et al. Closing the Gap Between Phenotypic and Genotypic Detection of Carbapenem Resistant Enterobacteriaceae by New Modified Carbapenem Inactivation Method. J of Clin and Diag. Res. 2018; 12(11).

Baran I, Aksu N. Phenotypic and genotypic characteristics of carbapenem-resistant Enterobacteriaceae in a tertiary-level reference hospital in Turkey. Annals of clinical microbiology and antimicrobials. 2016;15(1):20.

Bonnin RA, Bogaerts P, Girlich D, Huang TD, Dortet L, et al. Molecular characterization of OXA-198 carbapenemase- producing Pseudomonas aeruginosa clinical isolates. Antimicrobial agents and chemotherapy. 2018; 62(6):e02496- 17.

Begum N, Shamsuzzaman SM. Emergence of carbapenemase- producing urinary isolates at a tertiary care hospital in Dhaka, Bangladesh. Tzu Chi Medical Journal. 2016; 28(3):94-8.

Mohamed SE, Alobied A, Hussien WM, Saeed MI. blaOXA- 48 carbapenem resistant Pseudomonas aeruginosa clinical isolates in Sudan. Journal of Advances in Microbiology. 2018:1-5.

Van der Zee A, Roorda L, Bosman G, Fluit AC, et al. Multi- centre evaluation of real-time multiplex PCR for detection of carbapenemase genes OXA-48, VIM, IMP, NDM and KPC. BMC infectious diseases. 2014; 14(1):27.

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Published

2021-03-18

How to Cite

Sahrish, Y. ., Kaludi, Z. A. ., Ayub, S., Zia, K., Khan, M. A. ., & Khalid, N. . (2021). Superficial Surgical Site Infection after Primary Closure Versus Delayed Primary Closure of Wound in Perforated Appendicitis. Journal of Bahria University Medical and Dental College, 10(2), 94–97. https://doi.org/10.51985/JBUMDC2019126

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