# Surgical Site Infections and Antimicrobial Resistance: Six Years of Data from a Western Romanian Hospital

## TL;DR

This study analyzed six years of surgical site infection data from a Romanian hospital to assess the impact of the COVID-19 pandemic on infection rates and antimicrobial resistance.

## Contribution

The study provides insights into how the pandemic affected surgical site infections and antimicrobial resistance in a Western Romanian hospital.

## Key findings

- The average patient age was significantly lower during the pandemic period.
- Resistance to levofloxacin and ciprofloxacin decreased significantly post-pandemic.
- Pseudomonas aeruginosa and Enterococcus spp. were the most common bacteria in surgical site infections.

## Abstract

Background and Objectives: The onset of the COVID-19 pandemic posed a new challenge to hospital infection prevention measures and to the antimicrobial therapies adopted. The present study aimed to assess the influence of the COVID-19 pandemic on the dynamics of surgical site infection (SSI) rates and the variations in the microbiological profiles of the SSI. Materials and Methods: A retrospective, single-center study was conducted to examine data from patients who underwent conventional surgical procedures and developed SSI. The study was conducted at the First Surgery Clinic of the “Pius Brinzeu” Clinical Emergency Hospital, Timisoara, Romania. Data from 173 patients were analyzed over six years (from 26 February 2018 to 25 February 2024). The selected time interval was divided into three periods: pre-pandemic, pandemic, and post-pandemic. Results: During the pandemic, the average patient age was significantly lower than in the other periods. The average length of stay decreased consistently over the six-year study period. Among the 173 patients included in the study, 71.1% had a monobacterial infection, while the remaining 28.9% had infections involving at least two different bacteria. The two most commonly identified bacteria in more than 50% of the cases were Pseudomonas aeruginosa and Enterococcus spp. There was a significant decrease in bacterial resistance to levofloxacin and ciprofloxacin over the study period, with resistance dropping from 50% (pre-pandemic) and 53.3% (pandemic) to just 9.1% (post-pandemic). Conclusions: The COVID-19 pandemic substantially altered the SSI profile in our institution. The temporary increase in SSI frequency during the pandemic was likely related to shifts in surgical case mix and care delivery, rather than decreased infection control performance. Post-pandemic restoration of surgical flow coincided with improved antimicrobial susceptibility patterns, particularly for fluoroquinolones. Microbiological surveillance, the use of infection prevention measures, and robust stewardship initiatives remain essential to maintain these favorable trends and mitigate the emergence of future resistance.