Author(s): Saravanan M, Sajani Samuel, Sarath KE, Parthiban R


DOI: 10.52711/0974-360X.2023.00754   

Address: Saravanan M, Sajani Samuel, Sarath KE, Parthiban R*
Microbiology Division, Department of Clinical Laboratory Services and Translational Research,
Malabar Cancer Centre (Post Graduate Institute of Oncology Sciences and Research), Thalassery, Kerala – 670103.
*Corresponding Author

Published In:   Volume - 16,      Issue - 10,     Year - 2023

Cancer patients are susceptible to infections as a result of their disease and the immunosuppressive medication they undergo. Surgical Site Infection (SSIs) is the third most frequent nosocomial infection in hospitals around the world, trailing only urinary tract infections and pneumonia. Exogenous and/or endogenous bacteria that enter the operative site either during surgery (primary infection) or after surgery (secondary infection) are the most common causes of SSI. Pathogens that cause SSI in cancer patients have a wide variety of microbiological spectrums and antimicrobial susceptibilities. However, there is little information on the prevalence and incidence of resistant bacteria that cause SSI, particularly in Southern India, and epidemiological data on pathogens that cause SSI in cancer patients is scarce. As a result, the current study was conducted to examine the microorganisms and its antibiotic resistance isolated from SSIs in cancer patients at North Kerala. This retrospective study was conducted at a tertiary care cancer centre in North Kerala, India during the period from May 2021 to September 2021. Data of January 2018 and December 2020 on all microbial cultures from SSI were analysed. This study comprised clinical samples such as pus, pus aspirates, and wound swabs. Identification and resistance pattern of microorganism was performed by MALDI-TOF and VITEK – 2 compact respectively. S. aureus ATCC 25923, E. coli ATCC 25922, and P. aeruginosa ATCC 27853 were used as quality control strains. During the study period, 2949 patients underwent clean and clean contaminated surgical procedures. During the study period, a total of 215 individuals (7.2%) developed SSI. A total of 215 individuals with SSI were investigated, and 224 microorganisms were identified from 190 patients. S. aureus (39%) had the greatest isolation rate among the 224 bacterial isolates, followed by P. aeruginosa. MRSA was observed in 62% of the S. aureus isolates. Among the Enterobacteriaceae, K. pneumoniae showed higher resistant to ciprofloxacin (87%), cefepime (77.4%), and amikacin (45%). Among the Non-fermenting GNB, A. baumannii showed high-level resistance when compared to P. aeruginosa. To prevent the transmission of pathogenic organisms, we encourage rigorous adherence to appropriate sanitation practises such as thorough hand washing, disinfection of inanimate objects, and other infection control measures.

Cite this article:
Saravanan M, Sajani Samuel, Sarath KE, Parthiban R. Retrospective Investigation of Antibiotic resistance pattern by Microbial pathogens isolated in surgical site infections in cancer patients. Research Journal of Pharmacy and Technology 2023; 16(10):4635-1. doi: 10.52711/0974-360X.2023.00754

Saravanan M, Sajani Samuel, Sarath KE, Parthiban R. Retrospective Investigation of Antibiotic resistance pattern by Microbial pathogens isolated in surgical site infections in cancer patients. Research Journal of Pharmacy and Technology 2023; 16(10):4635-1. doi: 10.52711/0974-360X.2023.00754   Available on:

1.    Krishnaveni K, Jose R, Sumitha SK, Johny T, Shanmuga Sundaram R, Sambathkumar R. A Study on Socio Demographic and Associated Risk Factors for Cancer Patients in Private Cancer Hospital, Bangalore, India. Education. Research Journal of Pharmacy and Technology. 2018; 11(2): 677-680. doi: 10.5958/0974-360X.2018.00127.0
2.    Patel SK, Sinha M, Mitra M. Epidemiological and Socio-demographic Profile of Oral Cancer Patients of Chhattisgarh: A Retrospective Study. Research Journal of Science and Technology. 2012; 4(4):145-147. doi: Not available
3.    Sutton SH. Sutton SH. Infections Associated with Solid Malignancies. Infectious Complications in Cancer Patients. 2014; 161: 371.doi: 10.1007/978-3-319-04220-6_13
4.    Hernaiz-Leonardo JC, Golzarri MF, Cornejo-Juárez P, Volkow P, Velázquez C, Ostrosky-Frid M, Vilar-Compte D. Microbiology of surgical site infections in patients with cancer: A 7-year review. American Journal of Infection Control. 2017; 45(7):761-766. doi: Not available
5.    Haque M, Sartelli M, McKimm J, Bakar MA. Health care-associated infections–an overview. Infection and Drug Resistance. 2018; 12:2321-34. doi: 10.2147/IDR.S177247
6.    Ahmad R. Evaluation of the Gram-Negative Bacilli Causing Surgical-Site Infections and their Sensitivity to Antibiotics in Al-Mowasat Hospital, Damascus, Syria. Research Journal of Pharmacy and Technology. 2018; 11(5): 2070-3. doi: 10.5958/0974-360X.2018.00384.0  
7.    Manyahi J, Matee MI, Majigo M, Moyo S, Mshana SE, Lyamuya EF. Predominance of multi-drug resistant bacterial pathogens causing surgical site infections in Muhimbili National Hospital, Tanzania. BMC Res Notes. 2014;7:500. doi: 10.1186/1756-0500-7-500.
8.    Shah S, Singhal T, Naik R, Thakkar P. Predominance of multidrug-resistant Gram-negative organisms as cause of surgical site infections at a private tertiary care hospital in Mumbai, India. Indian Journal of Medical Microbiology. 2020; 38(3-4):344-50. doi: org/10.4103/ijmm.IJMM_20_284.
9.    Rajagopalan R, Shivamurthy MC. A Retrospective Evaluation of Compliance in Various Surgical Departments with Respect to Surgical Antibiotic Prophylaxis in a Tertiary Care Hospital. Research Journal of Pharmacy and Technology. 2013; 6(7): 749 – 752. doi: Not available
10.    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infection Control and Hospital Epidemiology. 1999; 20(4): 247-80.doi:
11.    Centers for Disease Control and Prevention. Procedure Associated Module: Surgical Site Infection (SSI) Event. Atlanta, GA: Centers for Disease Control and Prevention. 2017.
12.    Negi V, Pal S, Juyal D, Sharma MK, Sharma N. Bacteriological profile of surgical site infections and their antibiogram: A study from resource constrained rural setting of Uttarakhand State, India. Journal of Clinical and Diagnostic Research. 2015; 9(10): DC17.doi: 10.7860/JCDR/2015/15342.6698  
13.    Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, Reinke CE, et al. Healthcare Infection Control Practices Advisory Committee. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017; 152(8): 784-91. doi:10.1001/jamasurg.2017.0904
14.    Global Guidelines for the Prevention of Surgical Site Infection. Geneva: World Health Organization; 2018.
15.    Anderson DJ, Sexton DJ, Kanafani ZA, Auten G, Kaye KS. Severe surgical site infection in community hospitals: epidemiology, key procedures, and the changing prevalence of methicillin-resistant Staphylococcus aureus. Infection Control and Hospital Epidemiology. 2007;28(9):1047-53.doi: 10.1086/520731
16.    Seni J, Najjuka CF, Kateete DP, Makobore P, Joloba ML, Kajumbula H, et al.  Antimicrobial resistance in hospitalized surgical patients: a silently emerging public health concern in Uganda. BMC Research Notes. 2013; 6(1):1-7. doi: 10.1186/1756-0500-6-298
17.    Hope D, Ampaire L, Oyet C, Muwanguzi E, Twizerimana H, Apecu RO. Antimicrobial resistance in pathogenic aerobic bacteria causing surgical site infections in Mbarara regional referral hospital, Southwestern Uganda. Scientific Reports. 2019; 9(1): 1-10.  doi: org/10.1038/s41598-019-53712-2
18.    Prestinaci F, Pezzotti P, Pantosti A. Antimicrobial resistance: a global multifaceted phenomenon. Pathogens and Global Health. 2015; 109(7): 309-18. doi: 10.1179/2047773215Y.0000000030
19.    Chandanashree KS, Jacob J, Srivatsa S. Utilization Study of Antibiotics in Febrile Neutropenic Cancer patients with Bacteraemia. Research Journal of Pharmacy and Technology. 2020;13(8):3765-70. doi : 10.5958/0974-360X.2020.00666.6
20.    Monegro AF, Muppidi V, Regunath H. Hospital acquired infections. InStatPearls [Internet] 2020. StatPearls Publishing.
21.    Thomson WM, Sudha M, Venkateswaramurthy N, Kumar RS. A Review on the Irrational Antibiotics usage in Pediatrics for Respiratory Tract Infections. Research Journal of Pharmacy and Technology. 2019; 12(10): 5126-30.doi: 10.5958/0974 360X.2019.00888.6
22.    Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-seventh Informational Supplement. CLSI Document M100-S27. Wayne, PA: Clinical and Laboratory Standards Institute; January, 2017.
23.    Ramalingam AJ. History of Antibiotics and Evolution of Resistance. Research Journal of Pharmacy and Technology. 2015; 8(12): 1719-24. doi : 10.5958/0974-360X.2015.00309.1
24.    Zahran WA, Zein-Eldeen AA, Hamam SS, Sabal MS. Surgical site infections: Problem of multidrug-resistant bacteria. Menoufia Medical Journal. 2017; 30(4): 1005. doi: 10.4103/mmj.mmj_119_17
25.    Malinzak RA, Ritter MA, Berend ME, Meding JB, Olberding EM, Davis KE. Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates. The Journal of Arthroplasty. 2009; 24(6):84-8. doi: org/10.1016/j.arth.2009.05.016
26.    Dale H, Fenstad AM, Hallan G, Havelin LI, Furnes O, Overgaard S, Pedersen AB, et al. Increasing risk of prosthetic joint infection after total hip arthroplasty. Acta Orthop. 2012; 83(5):449-58. doi: 10.3109/17453674.2012.733918
27.    O'Connor RÍ, Kiely PA, Dunne CP. The relationship between post-surgery infection and breast cancer recurrence. Journal of Hospital Infection. 2020; 106(3): 522-535. doi: 10.1016/j.jhin.2020.08.004
28.    Giacometti A, Cirioni O, Schimizzi AM, Del Prete MS, Barchiesi F, D'errico MM, Petrelli E, et al. Epidemiology and microbiology of surgical wound infections. Journal of Clinical Microbiology. 2000; 38(2): 918-22. doi:org/10.1128/JCM.38.2.918-922.2000
29.    Rolston KV, Nesher L, Tarrand JT. Current microbiology of surgical site infections in patients with cancer: a retrospective review. Infectious Diseases and Therapy. 2014; 3(2):245-56.doi: 10.1007/s40121-014-0048-4
30.    Golia S, Kamath BA, Nirmala AR. A study of superficial surgical site infections in a tertiary care hospital at Bangalore.2014.
31.    Sumathi BG. Bacterial pathogens of surgical site infections in cancer patients at a tertiary regional cancer centre, South India. International Journal of Current Microbiology and Applied Sciences. 2016; 5: 605-16.doi: org/10.20546/ijcmas.2016.510.068
32.    Mawalla B, Mshana SE, Chalya PL, Imirzalioglu C, Mahalu W. Predictors of surgical site infections among patients undergoing major surgery at Bugando Medical Centre in Northwestern Tanzania. BMC Surgery. 2011; 11(1): 1-7.doi: 10.1186/1471-2482-11-21
33.    Abdelghafar A, Yousef N, Askoura M. Combating Staphylococcus aureus biofilm with Antibiofilm agents as an efficient strategy to control bacterial infection. Research Journal of Pharmacy and Technology. 2020; 13(11): 5601-6. doi: 10.5958/0974-360X.2020.00977.4
34.    Nazneen Siddiqui, SomnathNandkar, MuktaKhaparkuntikar and Arvind Gaikwad. Surveillance of post-operative wound infections along with their bacteriological profile and antibiotic sensitivity pattern at government cancer hospital, Aurangabad, India. Int J Curr Microbiol Appl Sci. 2017; 6: 595-600.doi: org/10.20546/ijcmas.2017.603.069
35.    Aljanaby AA, Aljanaby IA. Profile of Antimicrobial Resistance of Aerobic Pathogenic Bacteria isolated from Different Clinical Infections in Al-Kufa Central Hospital–Iraq During period from 2015 to 2017. Research Journal of Pharmacy and Technology. 2017;10(10):3264-70.doi: 10.5958/0974-360X.2017.00579.0
36.    Parthiban R, Sajani S, Saravanan M. Microbiological Profile and Antibiotic Resistance of Bloodstream Infections among Cancer Patients at a Tertiary Care Cancer Centre in North Kerala, India. National Journal of Laboratory Medicine. 2022; 11(1):  MO16-MO21. doi: 10.7860/NJLM/2022/50713.2576
37.    World Health Organization. Community-based surveillance of antimicrobial use and resistance in resource-constrained settings: report on five pilot projects. Geneva: World Health Organization; 2009.
38.    Tariq A, Ali H, Zafar F, Sial A, Hameed K, Naveed S. A systemic review on surgical site infections: classification, risk factors, treatment complexities, economical and clinical scenarios. Journal of Bioequivalence and Bioavailability. 2017;9(1):336-40.doi: 10.4172/jbb.1000321.
39.    Centers for Disease Control and Prevention (2015) surgical site infection (SSI) event.
40.    Ponto JA.ASHP statement on the pharmacist's role in antimicrobial stewardship and infection prevention and control. American Journal of Health-System Pharmacy. 2010;67(7):575-7. doi: 10.2146/sp100001
41.    Satishchandra A, Anusha R, Krishna EV, Eshwaraiah C. Prophylactic Antibiotics and Prevention of Surgical Site Infections. Research Journal of Pharmacy and Technology. 2021; 14(2):1091-3. doi: 10.5958/0974-360X.2021.00196.7

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