Figure 1
Overview of study processes. C-section:Cesarean section; POD:Post-operative day; SSI:Surgical-site infection; GP:General practitioner; NRL:National Reference Laboratory.
Table 1
Characteristics of participants presenting with SSI in study clinic (N = 45), from which 44 had infections that could be swabbed using the Levine Technique.
| n (%) | |
|---|---|
| SSI class | |
| Superficial | 40 (88.9) |
| Deep | 5 (11.1) |
| Time noticed SSI* | |
| Never | 22 (48.9) |
| 1–3 days | 17 (37.8) |
| 4–7 days | 4 (8.9) |
| Other post-operative complication | |
| Hematoma | 3 (6.8) |
| None | 41 (93.2) |
| SSI Treatment at POD 11 clinic** | |
| Antibiotics | 27 (61.4) |
| Daily dressings | 17 (38.6) |
| Wound opening | 9 (20.5) |
| Hospital admission | 3 (6.8) |
[i] * This data was missing from two patients with an SSI. ** Some participants received multiple treatments (N = 14, 31.8%).
Table 2
Prevalence of gram-negative bacteria in SSI wound isolates and proportion testing intermediate or resistant to each antimicrobial.
| GRAM-NEGATIVE, n = 39 | CTX n = 38 | CEFEP n = 39 | AMP n = 39 | AMOX/CLAV n = 39 | GENT n = 39 | AMIK n = 39 | CIPRO n = 39 | LEVOFLOX* n = 30 | PIP n = 39 | TETRA n = 39 | TMP-SMX n = 39 | IMI n = 39 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Bacteria | ||||||||||||
| E. coli (n = 3) | 100 | 100 | 100 | 0 | 33 | 0 | 33 | 0 | 0 | 66 | 100 | 0 |
| K. pneumoniae (n = 8) | 100 | 88 | 100 | 100 | 100 | 0 | 25 | 0 | 75 | 88 | 75 | 0 |
| Proteus. spp (n = 8) | 88 | 88 | 100 | 25 | 13 | 63 | 63 | 67 | 25 | 100 | 63 | 38 |
| E. cloacae complex (n = 8) | 100 | 100 | – | 100 | 75 | 13 | 13 | 0 | 50 | 75 | 88 | 13 |
| A. baumanii complex (n = 9) | 100 | 78 | – | – | 56 | – | 44 | 0 | 78 | 56 | 67 | 11 |
| Pseudomonas. spp (n = 2) | – | 0 | – | – | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| S. paucimobilis n = 1) | 100 | 100 | – | – | 100 | 100 | 100 | 0 | 100 | 100 | 100 | 0 |
[i] CTX:ceftriaxone; Cefep:cefepime; Amp:ampicillin; Amox/clav:amoxicillin-clavulanic acid; Gent:gentamicin; Amik:amikacin; Cipro:ciprofloxacin; Levoflox:levofloxacin; Pip:piperacillin-tazobactam; Tetra:tetracycline; TMP-SMX:trimethoprim-sulfamethoxazole; Imi:Imipenem; E. Coli:Escherichia coli; K. pneumoniae:Klebsiella pneumoniae; Proteus spp:Proteus species; E. cloacae complex:Enterobacter cloacae complex; A. baumanii complex:Acinetobacter baumanii complex; Pseudomonas spp:Pseudomonas species; S. Paucimobilis:Sphingomonas paucimobilis. *Antibiotics that were added to the testing panel 3 months into the study, % resistant/intermediate reported in table is based on number of isolates tested. – indicates “Not Tested”. All (n = 30, 100%) isolates tested were resistant to cefazolin and aztreonam. Of 30 isolates tested, 100% were susceptible to ertapenem, one isolate had intermediate susceptibility towards meropenem. Of 30 isolates tested against nitrofurantoin, 100% of K. pneumoniae and Proteus spp., 67% of E. cloacae complex, and 0% of E. coli were intermediate/resistant.
Table 3
Prevalence of gram-positive bacteria in SSI wound isolates and proportion testing intermediate or resistant to each antimicrobial.
| GRAM-POSITIVE, n = 18 | PCN n = 18 | OXA* n = 8 | CEFOX* n = 8 | TMP-SMX n = 18 | CLINDA** n = 18 | TETRA n = 18 | LEVOFLOX* ⤉ n = 8 | VANC n = 18 | LINEZ* n = 8 | RIF* n = 8 | TIGE* n = 8 | TEICO* n = 8 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Bacteria | ||||||||||||
| S. aureus (n = 2) | 100 | 0 | 100 | 100 | 0 | 50 | 0 | 0 | 0 | 0 | 0 | 0 |
| CoNS (n = 12) | 100 | 71 | 29 | 82 | 55 | 55 | 29 | 0 | 0 | 0 | 0 | 0 |
| S. pseudintermedius (n = 1) | 100 | – | – | 100 | 100 | 100 | – | 100 | – | – | – | – |
| L. lactis spp (n = 2) | 100 | – | – | 100 | 100 | 100 | – | 100 | – | – | – | – |
| K. rhizophilia (n = 1) | 100 | – | – | 100 | 100 | 100 | – | 100 | – | – | – | – |
[i] PCN:penicillin; Oxa:oxacillin; Cefox:cefoxitin; TMP-SMX:trimethoprim-sulfamethoxazole; Clinda:clindamycin; Tetra:tetracycline; Levoflox:levofloxacin; Vanc:vancomycin; Linez:linezolid; Rif:rifampicin; Tige:tigercycline; Teico:teicoplanin; S. aureus:Staphylococcus aureus; CoNS:coagulase-negative staphylococci; S. pseudintermedius:Staphylococcus pseudintermedius: L. lactis spp:Lactococcus lactis species; K. rhizophilia:Kocuria rhizophilia. - indicates “Not Tested.” * Antibiotics that were added to the testing panel 3 months into the study, % resistant/intermediate reported in table is based on number of isolates tested. ** Erythromycin susceptibility was concordant with clindamycin susceptibility except for one CoNS isolate that is clindamycin susceptible but erythromycin resistant. Two CoNS and no S. aureus isolates had inducible clindamycin resistance. ⤉ Moxifloxacin susceptibility was fully concordant with levofloxacin susceptibility.