# Epidemiology of Surgical Site Infections: Incidence and Risk Factors at Jimma University Specialized and Comprehensive Hospital, Ethiopia

## TL;DR

This study examines surgical site infections at a hospital in Ethiopia, finding a high incidence and significant risk factors, including multidrug-resistant bacteria.

## Contribution

The study provides new insights into SSI incidence and risk factors in a tertiary hospital in Ethiopia, highlighting the prevalence of drug-resistant bacteria.

## Key findings

- The incidence of SSI was 9.2 per 1000 person-days, with most cases occurring during hospitalization.
- E. coli, Acinetobacter, and Klebsiella were the most common bacterial isolates, with over 67% of Gram-negative bacteria being ESBL producers.
- Age, gender, emergency surgery, and hospitalization duration were significant risk factors for SSI.

## Abstract

Background: Surgical site infections (SSIs) are healthcare-associated infections that can occur following surgical procedures, either at admission or within 30 days post-discharge. This study aimed to assess the incidence and associated risk factors for superficial SSI at a Tertiary Hospital in Ethiopia. Methods: A longitudinal study was conducted among patients undergoing surgery at Jimma University Specialized and Comprehensive Hospital (JUSCH) from 1 June to 30 September 2022. Pus, wound swab, or abscess samples were inoculated on Blood and MacConkey Agar for culture. Bacterial isolates were identified using MALDI-TOF, antimicrobial susceptibility testing was performed using the Kirby–Bauer disc diffusion method, and the results were interpreted according to EUCAST 2022 breakpoints. Incidence rates, Kaplan–Meier analysis, extended Cox regression, and violin plots were utilized to analyze and present the findings. Results: Among 1205 participants, 629 (52.2%) were male, and the median age was 27 years (IQR: 16–40). The incidence of SSI was 9.2 per 1000 person-days. Most SSIs occurred during hospitalization (81.1%), and the remaining primarily developed within the first week post-discharge. The culture positivity rate was 72.7%, yielding 252 isolates comprising 36 bacterial species. The most frequently identified organisms were E. coli (22.2%), Acinetobacter (20.2%), and Klebsiella (14.7%). Over 67% of Gram-negative bacteria were ESBL producers. Age, gender, residence, hospital ward, surgery area, emergency surgery, longer hospitalization, and the number of staff attending the surgery were identified as important risk factors. Conclusions: This study revealed a high incidence of SSI during hospitalization, with significant proportion identified post-discharge. The high rates of multidrug-resistant Gram-negative pathogens underscore the urgent need for comprehensive infection prevention and control measures.