Abdominal surgical site infections: a prospective study of determinant factors in Harare, Zimbabwe

Surgical site infections (SSIs) are reported in lower frequencies in the developed countries than in the developing world. A prospective evaluation of risk factors in 285 patients undergoing abdominal surgery procedures in Zimbabwe was therefore undertaken. Overall infection rate was 26%. The age group 30-39 years had the highest number of dirty wounds and the highest rate of human immunodeficiency virus (HIV) infection. Multivariate regression analysis showed a correlation between wound class and SSI (P < 0.05). This was also noted for American Society of Anesthesiologists (ASA) score (P < 0.05). HIV-infected patients had 52% SSIs and non-infected patients had 26% (P < 0.05). Patients receiving blood transfusion had 51% SSIs and those not transfused had 17% (P < 0.01). Patients receiving pre- and intra-operative prophylactic antibiotics had 18% SSIs and those receiving postoperative administration had 37% (P < 0.01). Treatment ranged from dressings only in 11% to surgical intervention in 30% resulting in prolongation of median hospital stay from 8 to 18 days (P < 0.001). Mortality was 7%. High wound class, high ASA score, blood transfusion, HIV infection and delayed use of prophylactic antibiotics were risk factors for SSIs, resulting in surgical interventions, prolonged hospital stay and mortality.