Incidence of surgical site infections and prediction of risk factors in a hospital center in Morocco.

INTRODUCTION: Surgical site infections (SSIs) remain the major cause of morbidity and mortality in the postoperative period and are important surgical and hospital quality indicators. In this context, our study aims to identify SSIs associated risk factors and to develop a predictive model. METHODOLOGY: 2521 patients who underwent surgery, between June 2018 and May 2019, in four surgery departments, at the Taza Provincial Hospital (Morocco) were diagnosed for SSI according to the standards of the Center for Disease Control and Prevention. The SSIs' risk factors were assessed by univariate statistical analysis and logistic regression using the Scikit Learn function of Python. RESULTS: The average age of the studied population was 35 ± 1 years. The overall SSI incidence was 6.3% (17.95%, 6.86%, 6.67% and 3.16% respectively in child, female, male and gynaecological-obstetrical surgeries. The univariate statistical analysis has shown a highly significant (p < 0.001) and a very significant (p < 0.01) relationship between SSIs and almost all risk factors; and the logistic regression model has revealed a strong association between SSI and people who have had previous surgery, urinary catheter, antibiotic use duration, co-morbidity, American Society of Anesthesiologists (ASA) score, duration of intervention, emergency preoperative and postoperative durations, service, specialty and age range. The prediction score exceeds 96% which justifies our model's quality. CONCLUSIONS: SSIs are generally frequent among postoperative patients. Therefore, pre-operative preparation, post-operative surveillance and the environment quality of the wards are necessary to reduce SSI rates in the hospital.

The Relationship between Nasal Carriage of Staphylococcus aureus and Surgical Site Infections in a Hospital Center in Morocco.

BACKGROUND: Surgical site infection is a major public health problem in the world. Nasal carriage is a major risk factor for the development of nosocomial Staphylococcus aureus infection, especially methicillin-resistant Staphylococcus aureus (MRSA). Our work aims to determine the prevalence of Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, and the associated risk factors and to evaluate their sensitivity to 27 antibiotics. METHODS: A cross-sectional study was carried out on 100 patients, hospitalized in preoperative care of surgery units at the Taza Provincial Hospital Center in the Fez-Meknes region, from January to June 2019. Samples were taken from the patient's anterior nostril using single-use sterile dry or wet cotton swabs and then analyzed in the Provincial Public Health Laboratory in Taza. The carriage of Staphylococcus aureus was studied by conventional bacteriological methods by spreading nasal swabs on Chapman culture medium, while antibiotic resistance was determined by the Mueller-Hinton agar disc diffusion method according to the recommendations described by the Antibiogram Committee of the French Society of Microbiology 2019 (CA SFM 2019). RESULTS: Of the 84 patients found to be positive, 45.24% had coagulase-positive Staphylococcus aureus and 54.76% had coagulase-negative Staphylococcus. After surgery in the postoperative phase, 16 patients developed surgical site infections, of which two had a negative nasal culture and 14 had positive nasal culture. Among the Staphylococcus aureus-positive patients, 36.84% were colonized by a methicillin-resistant Staphylococcus aureus (MRSA) and 63.16% by a methicillin-sensitive Staphylococcus aureus (MSSA). Of these, 57.14% of MRSA colonized patients developed an infection of the surgical site and 42.85% showed no sign of SSI, while for patients colonized by MSSA, 16.67% developed SSI and 83.33% showed no sign of SSI. Moreover, children were the most affected by MRSA. Concerning antibiotic sensitivity, multiresistance of MRSA to more than 3 antibiotics has been found. CONCLUSION: To the best of our knowledge, this is the first study carried out in this hospital center with the aim of knowing the prevalence of nasal carriage of Staphylococcus aureus and MRSA and to identify the risk factors in order to prevent infections related to nasal carriage of Staphylococcus aureus and MRSA.

Acute intraperitoneal rupture of hydatid cysts: a surgical experience with 14 cases.

INTRODUCTION: Hydatidosis is endemic in the Mediterranean region including morrocco, the Middle and Far East, Australia, New Zealand, and South America-all areas where animal husbandry is common. Rupture into the abdominal cavity is a rare but serious complication of hydatid disease. The cysts may be ruptured after a trauma, or spontaneously as a result of increased intracystic pressure. Rupture of the hydatid cyst requires emergency surgical intervention. METHODS: Fourteen patients received surgical treatment for intraperitoneal rupture of the cysts over a period of 5 years. Age, gender, time to surgery from the onset of the symptoms, laboratory findings, diagnostic procedures, surgical treatment modalities, in-hospital stay, morbidity, mortality and recurrence were evaluated retrospectively. RESULTS: Eight of the patients were men and six were women. All of the patients had signs of peritoneal irritation. One patient (7,14%) had a history of blunt abdominal trauma. Ultrasonography scans revealed intra-abdominal fluid in all cases, intraperitoneal multiple cysts in 11 cases and heterogeneous cavity or cystic structures in the liver in 12 cases. Computed tomography showed multiple cystic lesions in the liver and peritoneum with intra-abdominal free fluid. The ruptured cysts were located in the right lobe of the liver in seven patients, in the left lobe in six patients and in both lobes in one patients. Procedures to fill the cystic cavities were applied after removal of the intraperitoneal fluid. Partial pericystectomy and drainage was the most frequent surgical procedure. No patients died in the early postoperative period. A total of seven morbidities developed in six patients (35.3%). Median hospital stay was 08 days and median follow-up was 12 months. Intra-abdominal recurrence occurred in one case (7.7%). CONCLUSIONS: Rupture of hydatid cysts into the peritoneal cavity, although rare, presents a challenge for surgeons. This pathology should be included in the differential diagnosis of acute abdomen in endemic areas. The operative procedures, either radical or conservative, should be based on the patient's condition, the regional characteristics, and the surgeon's experience. The morbidity and mortality rates of surgical interventions for ruptured hydatid cysts are higher than the rates for elective uncomplicated cases.