Surgical site infections after laparotomy in a tertiary Referral Hospital in Kenya: incidence and risk factors

Abstract

Introduction: Globally, surgical site infection (SSI) remains a major nosocomial infection, contributing significantly tomorbidity and mortality. Laparotomies are known to have higher reported rates of SSI compared to other types of surgery. SSIrates are generally higher in Low‐ and Middle‐Income Countries (LMIC) than in High Income Countries (HIC) for similarsurgical procedures, though specific rates in LMICs are often unknown. Identifying population‐specific risk factors is critical forimplementing effective SSI surveillance programs aimed at reducing the infection burden.Methodology: Data was collected retrospectively from 393 general surgery patients who underwent surgery between January2022 and December 2023. The study included all patients aged 14 years and above who had an exploratory laparotomy per-formed by the general surgery team. Bivariate analysis was performed to establish associations between variables and SSIoccurrence, followed by a stepwise multivariable logistic regression. SSI was defined as per the World Health Organization(WHO) and Center for Disease Control (CDC) criteria.Findings: The overall complication rate among the 393 patients was 26.7%. The study identified 55 cases of SSI, yielding anoverall SSI rate of 14.1%. 40.4% of SSI cases were classified as superficial, 32.7% as organ space, and 25% as deep. Wound culturewas only performed in 24 patients, with Escherichia coli being the most common organism found. Multivariable logisticregression identified three independent predictors of increased SSI risk: Operative Time: Each additional hour of operative timewas associated with a 68% increase in the odds of SSI (aOR = 1.68, 95% CI 1.149–2.455, p = 0.007). Sex: Female patients had 2.6times higher odds of developing SSI compared to male patients (aOR = 2.599, 95% CI 1.251–5.399, p = 0.01). Wound Class: Dirtywounds were associated with 2.34 times higher odds of infection compared to clean wounds (aOR = 2.343, 95% CI 1.123–4.886,p = 0.023).Conclusion: The SSI rate of 14.1% at MTRH highlights the considerable burden of infection following laparotomies in thissetting. Operative duration, patient sex, and wound contamination level are critical, modifiable and unmodifiable, independentrisk factors that should be targeted for surveillance and preventative programs in western Kenya