MICROBIAL ETIOLOGY AND ANTIBIOTIC RESISTANCE IN SURGICAL SITE INFECTIONS: IMPLICATIONS FOR OBSERVATIONAL TREATMENT

M NOMAN; L TARIQ; W KHALID; N ALI; . SHAHZAIB; A HASSAN; M HAROON

doi:10.54112/pjicm.v5i02.146

Authors

M NOMAN Medical Lab Sciences (MLS), Department of Pathology, Faculty of Medicine and Allied Health Sciences, The University of Faisalabad (TUF), Faisalabad, Punjab, Pakistan
L TARIQ Department of Pathology, Faculty of Allied Health Science, Faisalabad Medical University, Punjab, Pakistan
W KHALID Department of Epidemiology and Public Health, University of Agriculture, Faisalabad, Pakistan
N ALI Department of Medicine, Allied Hospital, Faisalabad, Faisalabad Medical University, Pakistan
. SHAHZAIB Department of Operating Theater Technology, Government College University, Faisalabad, Pakistan
A HASSAN Department of Rehabilitation Sciences, Faculty of Medicine and Allied Health Sciences, The University of Faisalabad (TUF), Faisalabad, Punjab, Pakistan
M HAROON Medical Lab Sciences (MLS), Department of Pathology, Faculty of Medicine and Allied Health Sciences, The University of Faisalabad (TUF), Faisalabad, Punjab, Pakistan

DOI:

https://doi.org/10.54112/pjicm.v5i02.146

Keywords:

Surgical Site Infection, Staphylococcus Aureus, Escherichia Coli, Antimicrobial Resistance, Kirby–Bauer Method

Abstract

Background: Surgical site infections (SSIs) remain a major contributor to postoperative morbidity, prolonged hospitalization, and increased healthcare costs. Rising antimicrobial resistance (AMR) among causative pathogens further complicates treatment, underscoring the need for local microbiological surveillance to guide empirical therapy. Objective: To determine the microbial etiology and antimicrobial susceptibility patterns of pathogens isolated from SSIs in postoperative patients. Study Design: Observational cross-sectional study. Setting: Department of Pathology, Allied Hospital, Faisalabad, Pakistan. Duration of Study: July 2022 to December 2022. Methods: A total of 100 wound swabs and pus specimens were collected from adult patients in surgical and orthopedic wards with clinically suspected SSIs. Samples were processed using standard microbiological protocols, and isolates were identified through biochemical testing. Antimicrobial susceptibility was evaluated using the Kirby–Bauer disk diffusion method, following CLSI guidelines. Data were analyzed with SPSS version 17.0. Results: Of the 100 bacterial isolates, 45% were Gram-positive and 55% were Gram-negative organisms. Staphylococcus aureus was the most frequent pathogen (43%), followed by Escherichia coli (36%), Pseudomonas spp. (9%), Proteus spp. (4%), and Klebsiella spp. (3%). S. aureus demonstrated high resistance to penicillin (88%) and ampicillin (82%) but remained fully susceptible to vancomycin (100%) and highly sensitive to linezolid (98%) and amikacin (90%). Gram-negative isolates showed high resistance to ampicillin (96.7%) and cotrimoxazole (93.3%), while colistin (100%), amikacin (88.3%), and meropenem (81%) were the most effective agents. Conclusion: S. aureus and E. coli were the predominant pathogens in SSIs, both exhibiting high resistance to first-line antibiotics. Culture-guided therapy, reinforced infection control practices, and continuous antimicrobial surveillance are critical to improving SSI management and combating AMR in surgical settings.

References

Li L. and Cui H. The risk factors and care measures of surgical site infection after cesarean section in China: a retrospective analysis. BMC Surgery 2021;21(1). https://doi.org/10.1186/s12893-021-01154-x

Menz B., Charani E., Gordon D., Leather A., Moonesinghe R., & Phillips C. Surgical antibiotic prophylaxis in an era of antibiotic resistance: common resistant bacteria and wider considerations for practice. Infection and Drug Resistance 2021; Volume 14:5235-5252. https://doi.org/10.2147/idr.s319780

Shrestha A. and Pradhan N.. Analysis of the risk factors and microbial etiology of surgical site infections following lower segment caesarean section. Sri Lanka Journal of Obstetrics and Gynaecology 2019;41(1):15. https://doi.org/10.4038/sljog.v41i1.7828

Ottong D., Udemezue O., Ezeamalu C., Udemezue O., & Okoye P. Etiological agents of superficial surgical site infections among postoperative patients attending a teaching hospital in southeastern Nigeria. International Journal of Pathogen Research 2024;13(6):1-8. https://doi.org/10.9734/ijpr/2024/v13i6316

Nimbkar A., Panchbudhe S., & Deshmukh P. An interesting case of a nonhealing obstetric surgical site infection of a concomitant rare fungal and tuberculous origin. Journal of South Asian Federation of Obstetrics and Gynaecology 2022;14(2):207-209. https://doi.org/10.5005/jp-journals-10006-2009

Vishnoi V., Hoedt E., Gould T., Carroll G., Carroll R., Lott N.et al.. A pilot study: intraoperative 16s rrna sequencing versus culture in predicting colorectal incisional surgical site infection. Australian and New Zealand Journal of Surgery 2023;93(10):2464-2472. https://doi.org/10.1111/ans.18455

Birgand G., Azevedo C., Rukly S., Pissard-Gibollet R., Toupet G., Timsit J.et al.. Motion-capture system to assess intraoperative staff movements and door openings: impact on surrogates of the infectious risk in surgery. Infection Control and Hospital Epidemiology 2019;40(05):566-573. https://doi.org/10.1017/ice.2019.35

Galam P., Desai Y., Patel A., Bajpayee L., & Shetty K. Efficacy and safety of Mitsu ab™ triclosan-coated sutures in preventing surgical site infections. Cureus 2025. https://doi.org/10.7759/cureus.84246

Baygar T.. Characterization of silk sutures coated with propolis and biogenic silver nanoparticles (agnps); an eco-friendly solution with wound healing potential against surgical site infections (ssis). Turkish Journal of Medical Sciences 2019. https://doi.org/10.3906/sag-1906-48

Adane F., Mulu A., Seyoum G., Gebrie A., & Lake A. Prevalence and root causes of surgical site infection among women undergoing caesarean section in Ethiopia: a systematic review and meta-analysis. Patient Safety in Surgery 2019;13(1). https://doi.org/10.1186/s13037-019-0212-6

Misha G., Chelkeba L., & Melaku T. Bacterial profile and antimicrobial susceptibility patterns of isolates among patients diagnosed with surgical site infection at a tertiary teaching hospital in Ethiopia: a prospective cohort study—Annals of Clinical Microbiology and Antimicrobials 2021;20(1). https://doi.org/10.1186/s12941-021-00440-z

Rerung D. and Andar E.. The incidence of surgical site infections in neurosurgery procedures during January–December 2017 in Kariadi General Hospital, Indonesia. Indonesian Journal of Neurosurgery 2020;3(3). https://doi.org/10.15562/ijn.v3i3.98

Fakouri A., Razavi Z., Mohammed A., Hussein A., Afkhami H., & Hooshiar M. Applications of mesenchymal stem cell-exosome components in wound infection healing: new insights. Burns & Trauma 2024;12. https://doi.org/10.1093/burnst/tkae021

Oba A. and Nuhu A. Prevalence and antibiotic resistance profile of Staphylococcus aureus isolated from post-operative wounds in secondary health facilities of Ilorin metropolis, Kwara State, Nigeria. Umyu Journal of Microbiology Research (Ujmr) 2023;8(1):101-108. https://doi.org/10.47430/ujmr.2381.013

Amulioto J., Muturi M., Mathenge S., & Mutua G. Antibiotic susceptibility patterns of bacterial isolates in post-operative wound infections among patients attending Mama Lucy Kibaki Hospital, Kenya. 2019. https://doi.org/10.21203/rs.2.17645/v1

Begum P., Rajeshkumar R., Manigandan V., Balasubramaniam V., Ponnusankar S., Dhama K.et al.. The emerging paradigm of antimicrobial resistance in surgical site infections of the Nilgiris region. Journal of Pure and Applied Microbiology 2023;17(2):900-910. https://doi.org/10.22207/jpam.17.2.16

Nguyen A., Nguyen H., Le V., Van H., Hải N., Luong V.et al.. Antimicrobial susceptibility profile of methicillin-resistant Staphylococcus aureus isolated from clinical samples at Bac Ninh Provincial General Hospital, Vietnam. Infection and Drug Resistance 2024; Volume 17:4113-4123. https://doi.org/10.2147/idr.s477031

Troeman D., Hazard D., Timbermont L., Malhotra‐Kumar S., Werkhoven C., Wolkewitz M.et al.. Postoperative Staphylococcus aureus infections in patients with and without preoperative colonization. Jama Network Open 2023;6(10):e2339793. https://doi.org/10.1001/jamanetworkopen.2023.39793

Akhter M., Akter N., Ahsan S., & Chowdhury F. Antibiotic sensitivity and virulence genes in Staphylococcus aureus isolates from surgical site infection. Bangladesh Journal of Microbiology, 2021; 38(1): 21-26. https://doi.org/10.3329/bjm.v38i1.55532

Bassey E., AROTUPIN D., & AJAYI B.. Comparative efficacy of medicated soaps on Staphylococcus aureus associated with wounds and post-operative wounds from hospitals in Ondo State, Nigeria. Bacterial Empire 2022:e377. https://doi.org/10.36547/be.377

Noor S., Faridi T., John A., Hassan T., Noor A., Noor A.et al.. A study of microorganisms causing wound infections after elective laparotomy. Pakistan Biomedical Journal 2021;4(2). https://doi.org/10.54393/pbmj.v4i2.63

Bhattarai S., Nalbo D., Koirala S., & Singh R. Prevalence of surgical site infection among bile spillage and non-spillage patients undergoing laparoscopic cholecystectomy: a cross-sectional study. Birat Journal of Health Sciences 2022;7(2):1804-1807. https://doi.org/10.3126/bjhs.v7i2.49305

Aslam M., Raza M., Hurera A., Iqbal A., Ilyas F., & Irum T. Different effective infection control strategies for preventing methicillin-resistant Staphylococcus aureus-related surgical site infections (ssi) in Pakistan. 2025. https://doi.org/10.1101/2025.04.28.25326580