The incidence of surgical infection has been decreased along with development of new anti biotics and aseptic surgical technique, but no improvement was noted in patients with malignant disease and transplant patient. And resistance to
antibiotics
and
change of strains of bacteria are great obstacle to the prevention of surgical infection.
To examine the chronological changes of surgical infection, authors compared the incidence of surgical infection, class of infectious disease and changes of infectious agents in sixty one patients during the period of 1981 through 1983 with those
of one
hundred twenty one patients in 1991 who received operation at Deparment of Surgery, SNUH. They were all afebrile preoperatively and bacteriologically identified poostoperatively. And the results were as follows;
1) The overall incidence of surgical infection in 1991(4.58%) was significantly decreased in comparison with that of surgical infection in 1981~83(7.89%) p<.05(Table 1).
2) The decrement of incidence of surgical infection was observed in malignant pancreatobiliary disease(65.0% vs 15.6%). The incidence gradually increased in order of pancreatobiliary, colorectal, liver, stomah, and breast carcer(Table 2).
3) The infectious complication was the most frequent after kidney transplantation among benign diseases, but the change of incidence was not significant between the two periods(p>.05)(Table 3).
4) Among malignant diseases, Pseudomonads(18.8%), Proteus(15.9%) and E coli(13.6%) were the main infectious agent during the period of 1981 through 1983. But this order were different from 1991 as E. coli(20.8%), coagulase(-) Streptococcus
(18.5%),
Pseudomonads(16.2%), Proteus infetion has been decreased whereas coagulase(-) staphylococcus has been increased(p<.5) (Table 4).
5) Among benign diseases, Pseudomonads(23.7%), E. coli(21.1%) were main infectious agents during the period of 1981 through 1983. Enterobacter(30.5%) and coagulase(-) Staphylococcus (18.6%) were main infectious agent in 1991. Gram-postive agent
and
Enterobactor were increased st6afistifically significant(p<.5)(Table 5).
6) Methicillin resistant Staphylooccus aureus(MRSA) strain was 50% during the period of 1981 thorugh 1983 and 71.6% in 1991. But the difference was not significant statistically (p>.05).
7) the susceptibility test to chloramphenicol aganinst MRSA(47.3%) was the most superior toall other antibiotics(e.g., 16.2 in clindamycin and trimethoprim/sufamethoxasole respectively). And MRSA was 100% resistant to cefotaxime and gentamicin
In conclusion, the general trend of surgical infection is decreasing now, but this trend is not detectable in transplant patients and patients with malignant disease except pancreatobiliary system. And recently Gram-positive organism was most
frequent
infections agent when it compared to 10 years ago.
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