ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
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Zahran WA, Zein-Eldeen AA, Hamam SS, Sabal MS, 2017. Surgical site infections: Problem of multidrug-resistant bacteria. Menoufia Med J 30: 1005.
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Koyagura B, Koramutla HK, Ravindran B, Kandati J, 2018. Surgical site infections in orthopaedic surgeries: Incidence and risk factors at tertiary care hospital of South India. Int J Res Orthop 4: 551.
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3.
Lakoh S, et al., 2022. The burden of surgical site infections and related antibiotic resistance in two geographic regions of Sierra Leone: A prospective study. Ther Adv Infect Dis 9: 20499361221135128.
-
4.
Kisibo A, Ndume VA, Semiono A, Mika E, Sariah A, Protas J, Landolin H, 2017. Surgical site infection among patients undergone orthopaedic surgery at Muhimbili Orthopaedic Institute, Dar Es Salaam, Tanzania. East Cent Afr J Surg 22: 49–58.
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5.
Jain RK, Shukla R, Singh P, Kumar R, 2015. Epidemiology and risk factors for surgical site infections in patients requiring orthopedic surgery. Eur J Orthop Surg Traumatol 25: 251–254.
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6.
Taherpour N, Mehrabi Y, Seifi A, Eshrati B, Hashemi Nazari SS, 2021. Epidemiologic characteristics of orthopedic surgical site infections and under-reporting estimation of registries using capture-recapture analysis. BMC Infect Dis 21: 1–7.
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7.
Al-Mulhim FA, Baragbah MA, Sadat-Ali M, Alomran AS, Azam MQ, 2014. Prevalence of surgical site infection in orthopedic surgery: A 5-year analysis. Int Surg 99: 264–268.
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8.
Borthakur B, Kumar S, Talukdar M, Bidyananda A, 2016. Surgical site infection in orthopaedics. Int J Orthop Sci 2: 113–117.
-
9.
Misha G, Chelkeba L, Melaku T, 2021. Bacterial profile and antimicrobial susceptibility patterns of isolates among patients diagnosed with surgical site infection at a tertiary teaching hospital in Ethiopia: A prospective cohort study. Ann Clin Microbiol Antimicrob 20: 33.
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10.
Broussard A, 2009. CE examination: Management and prevention of infection in orthopedic surgical procedures. Surg Technol 41: 547.
-
11.
Hope D, Ampaire L, Oyet C, Muwanguzi E, Twizerimana H, Apecu RO, 2019. Antimicrobial resistance in pathogenic aerobic bacteria causing surgical site infections in Mbarara regional referral hospital, southwestern Uganda. Sci Rep 9: 17299.
-
12.
Bolon MK, et al., 2009. Improved surveillance for surgical site infections after orthopedic implantation procedures: Extending applications for automated data. Clin Infect Dis 48: 1223–1229.
-
13.
National Trauma Center, 2023. National Academy of Medical Sciences. Background. Available at: https://nationaltraumacenter.gov.np/en/pages/background. Accessed April 19, 2023.
-
14.
Abayneh M, Asnake M, Muleta D, Simieneh A, 2022. Assessment of bacterial profiles and antimicrobial susceptibility pattern of isolates among patients diagnosed with surgical site infections at Mizan-Tepi University Teaching Hospital, Southwest Ethiopia: A prospective observational cohort study. Infect Drug Resist 1: 1807–1819.
-
15.
The Center for Disease Control and Prevention, 2024. Surgical Site Infection Event (SSI). Available at: https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Accessed March 24, 2024.
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16.
Procop GW, Church DL, Hall GS, Janda WM, 2022. Koneman’s Color Atlas and Textbook of Diagnostic Microbiology. Burlington, MA: Jones & Bartlett Publishers.
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Clinical and Laboratory Standards Institute, 2020. CLSI document M100S. Performance Standards for Antimicrobial Susceptibility Testing. 30th ed. Wayne, PA: CLSI.
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Waitz JA, 1990. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically .Wayne, PA: National Committee for Clinical Laboratory Standards.
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European Center for Disease Prevention and Control, 2013. Surveillance of Surgical Site Infections in Europe 2010–2011. Stockholm, Sweden: ECDC.
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Centers for Disease Control and Prevention, 2016. National and State Healthcare-Associated Infections Progress Report. Atlanta, GA: National Center for Emerging and Zoonotic Infectious Diseases. Available at: http://www.cdc.gov/HAI/pdfs/progressreport/hai-progress-report.pdf. Accessed April 19, 2023.
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21.
Khanam RA, Islam MR, Sharif A, Parveen R, Sharmin I, Yusuf MA, 2018. Bacteriological profiles of pus with antimicrobial sensitivity pattern at a teaching hospital in Dhaka City. Bangladesh J 5: 10–14.
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22.
Amatya J, Rijal M, Baidya R, 2015. Bacteriological study of the postoperative wound samples and antibiotic susceptibility pattern of the isolates in BB hospital. JSM Microbiol 3: 1019.
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23.
Regmi SM, Sharma BK, Lamichhane PP, Gautam G, Pradhan S, Kuwar R, 2020. Bacteriological profile and antimicrobial susceptibility patterns of wound infections among adult patients attending Gandaki Medical College Teaching Hospital, Nepal. J Gandaki Medical College—Nepal 13: 60–64.
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24.
Mohammed A, Adeshina GO, Ibrahim YK, 2013. Incidence and antibiotic susceptibility pattern of bacterial isolates from wound infections in a tertiary hospital in Nigeria. Trop J Pharm Res 12: 617–621.
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25.
Dessalegn L, Shimelis T, Tadesse E, Gebre-selassie S, 2014. Aerobic bacterial isolates from post-surgical wound and their antimicrobial susceptibility pattern: A hospital based cross-sectional study. J Med Res 3: 18–23.
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26.
Seni J, Najjuka CF, Kateete DP, Makobore P, Joloba ML, Kajumbula H, Kapesa A, Bwanga F, 2013. Antimicrobial resistance in hospitalized surgical patients: A silently emerging public health concern in Uganda. BMC Res Notes 6: 1–7.
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Chaudhary R, Thapa SK, Rana JC, Shah PK, 2017. Surgical site infections and antimicrobial resistance pattern. J Nepal Health Res Counc 15: 120–123.
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28.
Bhat AK, Parikh NK, Acharya A, 2018. Orthopaedic surgical site infections: A prospective cohort study. Can J Infect Control 33: 227–229.
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29.
Geubbels EL, Nagelkerke NJ, Mintjes-De Groot AJ, Vandenbroucke-Grauls CM, Grobbee DE, De Boer AS, 2006. Reduced risk of surgical site infections through surveillance in a network. Int J Qual Health Care 18: 127–133.
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Mardanpour K, Rahbar M, Mardanpour S, Mardanpour N, 2017. Surgical site infections in orthopedic surgery: Incidence and risk factors at an Iranian teaching hospital. Clinical Trials in Orthopedic Disorders 2: 132.
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O’Rourke RW, Kay T, Lyle EA, Traxler SA, Deveney CW, Jobe BA, Roberts CT, Marks D, Rosenbaum JT, 2006. Alterations in peripheral blood lymphocyte cytokine expression in obesity. Clin Exp Immunol 146: 39–46.
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32.
Acharya J, Mishra SK, Kattel HP, Rijal B, Pokhrel BM, 2008. Bacteriology of wound infections among patients attending Tribhuvan University Teaching Hospital, Kathmandu, Nepal. J Nepal Assoc Med Laboratory Sci 9: 76–80.
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33.
Ter Gunne AF, Cohen DB, 2009. Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine 34: 1422–1428.
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34.
Liang Z, Rong K, Gu W, Yu X, Fang R, Deng Y, Lu L, 2019. Surgical site infection following elective orthopaedic surgeries in geriatric patients: Incidence and associated risk factors. Int Wound J 16: 773–780.
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Călina D, et al., 2017. Antimicrobial resistance development following surgical site infections. Mol Med Rep 15: 681–688.
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36.
Girma G, Gebre K, Himanot T, 2013. Multidrug resistant bacteria isolates in infected wounds at Jimma University Specialized Hospitals, Ethiopia. Ann Clin Microbiol Antimicrob 12: 1–7.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 4979 | 4979 | 84 |
| Full Text Views | 79 | 79 | 11 |
| PDF Downloads | 68 | 68 | 8 |
Antimicrobial Resistance in Bacterial Species Causing Orthopaedic Surgical Site Infections at a National Trauma Center, Kathmandu, Nepal
Ajaya Basnet
Ajaya Basnet
Department of Medical Microbiology, Shi-Gan International College of Science and Technology, Tribhuvan University, Kathmandu, Nepal;
Department of Microbiology, Nepal Armed Police Force Hospital, Kathmandu, Nepal;
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Department of Microbiology, Nepal Armed Police Force Hospital, Kathmandu, Nepal;
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Pramod Joshi
researchdev108@gmail.com
Pramod Joshi
Department of Orthopaedic, National Trauma Center, Kathmandu, Nepal;
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Sailendra Kumar Duwal Shrestha
Sailendra Kumar Duwal Shrestha
Department of Orthopaedic, Nepal Armed Police Force Hospital, Kathmandu, Nepal;
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Laxmi Kant Khanal
Laxmi Kant Khanal
Department of Research and Microbiology, Nepal Medical College and Teaching Hospital, Attarkhel, Kathmandu, Nepal
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Mahesh Karmacharya
Mahesh Karmacharya
Department of Orthopaedic, National Trauma Center, Kathmandu, Nepal;
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Shila Shrestha
Shila Shrestha
Department of Medical Microbiology, Shi-Gan International College of Science and Technology, Tribhuvan University, Kathmandu, Nepal;
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Shiba Kumar Rai
Shiba Kumar Rai
Department of Research and Microbiology, Nepal Medical College and Teaching Hospital, Attarkhel, Kathmandu, Nepal
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ABSTRACT.
Hospital-acquired infections, including surgical site infections (SSIs), pose a concerning challenge because of the growing resistance to multiple drugs, largely influenced by extensive prophylactic antimicrobial therapy. Although SSIs are well documented in advanced hospitals in developed nations, their prevalence and bacterial profiles are inadequately reported in low- and middle-income nations such as Nepal. This retrospective cohort study explored the prevalence of orthopaedic SSIs in relation to bacterial etiology and antimicrobial resistance. We examined the surgical and bacteriological records of patients suffering SSIs (clean or clean-contaminated wounds) within a month of their surgical procedures between January 2020 and June 2022 at the National Trauma Center, Kathmandu, Nepal. The prevalence of orthopaedic SSIs among hospital-visiting patients was 31.2% (448/1,438; 95% CI: 28.8–33.5). There were 341 (76.1%) males and 361 (80.6%) adults with SSIs. Knee/joint infections (n = 141, 31.5%) were predominant. An SSI typically occurs 7 days after surgery. Enterobacterales were dominated by Escherichia coli (n = 54, 40.9%), whereas nonfermenters gram-positive cocci (GPC) were dominated by Pseudomonas aeruginosa (n = 69, 81.2%) and Staphylococcus aureus (n = 216, 93.5%), respectively. Enterobacterales, nonfermenters, and GPC exhibited penicillin resistance at 74.5%, 29.8%, and 65.1%, respectively, whereas cephalosporin resistance was exhibited at 48.3%, 57.1%, and 49.6%; fluoroquinolone resistance at 25.9%, 40.5%, and 25.7%; and aminoglycoside resistance at 21.5%, 43.2%, and 17.3%. One-third of orthopaedic surgeries resulted in SSIs, mainly caused by S. aureus. Fluoroquinolones and aminoglycosides were moderately effective in treating bacterial SSIs, whereas penicillins and cephalosporins were the least effective. Nonfermenters exhibited higher antimicrobial resistance compared with Enterobacterales and GPC.
- Supplemental Materials (PDF 600.51 KB)
Author Notes
Current contact information: Ajaya Basnet, Department of Medical Microbiology, Shi-Gan International College of Science and Technology, Tribhuvan University, Kathmandu, Nepal, and Department of Microbiology, Nepal Armed Police Force Hospital, Kathmandu, Nepal, E-mail: xlcprk@gmail.com. Pramod Joshi, Research Section, Nepal Health Research Council, Kathmandu, Nepal, E-mail: researchdev108@gmail.com. Mahesh Karmacharya, Department of Orthopaedics, National Trauma Center, Kathmandu, Nepal, E-mail: maheshkarmacharya73@gmail.com. Sailendra Kumar Duwal Shrestha, Department of Orthopaedics, Nepal Armed Police Force Hospital, Kathmandu, Nepal, E-mail: drsailendra39@gmail.com. Laxmi Kant Khanal and Shiba Kumar Rai, Department of Microbiology, Nepal Medical College Teaching Hospital, Kathmandu, Nepal, E-mails: khanallk2017@gmail.com and drshibakrai@gmail.com. Shila Shrestha, Department of Medical Microbiology, Shi-Gan International College of Science and Technology, Tribhuvan University, Kathmandu, Nepal, E-mail: microbiologistshila@gmail.com.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Zahran WA, Zein-Eldeen AA, Hamam SS, Sabal MS, 2017. Surgical site infections: Problem of multidrug-resistant bacteria. Menoufia Med J 30: 1005.
-
2.
Koyagura B, Koramutla HK, Ravindran B, Kandati J, 2018. Surgical site infections in orthopaedic surgeries: Incidence and risk factors at tertiary care hospital of South India. Int J Res Orthop 4: 551.
-
3.
Lakoh S, et al., 2022. The burden of surgical site infections and related antibiotic resistance in two geographic regions of Sierra Leone: A prospective study. Ther Adv Infect Dis 9: 20499361221135128.
-
4.
Kisibo A, Ndume VA, Semiono A, Mika E, Sariah A, Protas J, Landolin H, 2017. Surgical site infection among patients undergone orthopaedic surgery at Muhimbili Orthopaedic Institute, Dar Es Salaam, Tanzania. East Cent Afr J Surg 22: 49–58.
-
5.
Jain RK, Shukla R, Singh P, Kumar R, 2015. Epidemiology and risk factors for surgical site infections in patients requiring orthopedic surgery. Eur J Orthop Surg Traumatol 25: 251–254.
-
6.
Taherpour N, Mehrabi Y, Seifi A, Eshrati B, Hashemi Nazari SS, 2021. Epidemiologic characteristics of orthopedic surgical site infections and under-reporting estimation of registries using capture-recapture analysis. BMC Infect Dis 21: 1–7.
-
7.
Al-Mulhim FA, Baragbah MA, Sadat-Ali M, Alomran AS, Azam MQ, 2014. Prevalence of surgical site infection in orthopedic surgery: A 5-year analysis. Int Surg 99: 264–268.
-
8.
Borthakur B, Kumar S, Talukdar M, Bidyananda A, 2016. Surgical site infection in orthopaedics. Int J Orthop Sci 2: 113–117.
-
9.
Misha G, Chelkeba L, Melaku T, 2021. Bacterial profile and antimicrobial susceptibility patterns of isolates among patients diagnosed with surgical site infection at a tertiary teaching hospital in Ethiopia: A prospective cohort study. Ann Clin Microbiol Antimicrob 20: 33.
-
10.
Broussard A, 2009. CE examination: Management and prevention of infection in orthopedic surgical procedures. Surg Technol 41: 547.
-
11.
Hope D, Ampaire L, Oyet C, Muwanguzi E, Twizerimana H, Apecu RO, 2019. Antimicrobial resistance in pathogenic aerobic bacteria causing surgical site infections in Mbarara regional referral hospital, southwestern Uganda. Sci Rep 9: 17299.
-
12.
Bolon MK, et al., 2009. Improved surveillance for surgical site infections after orthopedic implantation procedures: Extending applications for automated data. Clin Infect Dis 48: 1223–1229.
-
13.
National Trauma Center, 2023. National Academy of Medical Sciences. Background. Available at: https://nationaltraumacenter.gov.np/en/pages/background. Accessed April 19, 2023.
-
14.
Abayneh M, Asnake M, Muleta D, Simieneh A, 2022. Assessment of bacterial profiles and antimicrobial susceptibility pattern of isolates among patients diagnosed with surgical site infections at Mizan-Tepi University Teaching Hospital, Southwest Ethiopia: A prospective observational cohort study. Infect Drug Resist 1: 1807–1819.
-
15.
The Center for Disease Control and Prevention, 2024. Surgical Site Infection Event (SSI). Available at: https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Accessed March 24, 2024.
-
16.
Procop GW, Church DL, Hall GS, Janda WM, 2022. Koneman’s Color Atlas and Textbook of Diagnostic Microbiology. Burlington, MA: Jones & Bartlett Publishers.
-
17.
Clinical and Laboratory Standards Institute, 2020. CLSI document M100S. Performance Standards for Antimicrobial Susceptibility Testing. 30th ed. Wayne, PA: CLSI.
-
18.
Waitz JA, 1990. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically .Wayne, PA: National Committee for Clinical Laboratory Standards.
-
19.
European Center for Disease Prevention and Control, 2013. Surveillance of Surgical Site Infections in Europe 2010–2011. Stockholm, Sweden: ECDC.
-
20.
Centers for Disease Control and Prevention, 2016. National and State Healthcare-Associated Infections Progress Report. Atlanta, GA: National Center for Emerging and Zoonotic Infectious Diseases. Available at: http://www.cdc.gov/HAI/pdfs/progressreport/hai-progress-report.pdf. Accessed April 19, 2023.
-
21.
Khanam RA, Islam MR, Sharif A, Parveen R, Sharmin I, Yusuf MA, 2018. Bacteriological profiles of pus with antimicrobial sensitivity pattern at a teaching hospital in Dhaka City. Bangladesh J 5: 10–14.
-
22.
Amatya J, Rijal M, Baidya R, 2015. Bacteriological study of the postoperative wound samples and antibiotic susceptibility pattern of the isolates in BB hospital. JSM Microbiol 3: 1019.
-
23.
Regmi SM, Sharma BK, Lamichhane PP, Gautam G, Pradhan S, Kuwar R, 2020. Bacteriological profile and antimicrobial susceptibility patterns of wound infections among adult patients attending Gandaki Medical College Teaching Hospital, Nepal. J Gandaki Medical College—Nepal 13: 60–64.
-
24.
Mohammed A, Adeshina GO, Ibrahim YK, 2013. Incidence and antibiotic susceptibility pattern of bacterial isolates from wound infections in a tertiary hospital in Nigeria. Trop J Pharm Res 12: 617–621.
-
25.
Dessalegn L, Shimelis T, Tadesse E, Gebre-selassie S, 2014. Aerobic bacterial isolates from post-surgical wound and their antimicrobial susceptibility pattern: A hospital based cross-sectional study. J Med Res 3: 18–23.
-
26.
Seni J, Najjuka CF, Kateete DP, Makobore P, Joloba ML, Kajumbula H, Kapesa A, Bwanga F, 2013. Antimicrobial resistance in hospitalized surgical patients: A silently emerging public health concern in Uganda. BMC Res Notes 6: 1–7.
-
27.
Chaudhary R, Thapa SK, Rana JC, Shah PK, 2017. Surgical site infections and antimicrobial resistance pattern. J Nepal Health Res Counc 15: 120–123.
-
28.
Bhat AK, Parikh NK, Acharya A, 2018. Orthopaedic surgical site infections: A prospective cohort study. Can J Infect Control 33: 227–229.
-
29.
Geubbels EL, Nagelkerke NJ, Mintjes-De Groot AJ, Vandenbroucke-Grauls CM, Grobbee DE, De Boer AS, 2006. Reduced risk of surgical site infections through surveillance in a network. Int J Qual Health Care 18: 127–133.
-
30.
Mardanpour K, Rahbar M, Mardanpour S, Mardanpour N, 2017. Surgical site infections in orthopedic surgery: Incidence and risk factors at an Iranian teaching hospital. Clinical Trials in Orthopedic Disorders 2: 132.
-
31.
O’Rourke RW, Kay T, Lyle EA, Traxler SA, Deveney CW, Jobe BA, Roberts CT, Marks D, Rosenbaum JT, 2006. Alterations in peripheral blood lymphocyte cytokine expression in obesity. Clin Exp Immunol 146: 39–46.
-
32.
Acharya J, Mishra SK, Kattel HP, Rijal B, Pokhrel BM, 2008. Bacteriology of wound infections among patients attending Tribhuvan University Teaching Hospital, Kathmandu, Nepal. J Nepal Assoc Med Laboratory Sci 9: 76–80.
-
33.
Ter Gunne AF, Cohen DB, 2009. Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine 34: 1422–1428.
-
34.
Liang Z, Rong K, Gu W, Yu X, Fang R, Deng Y, Lu L, 2019. Surgical site infection following elective orthopaedic surgeries in geriatric patients: Incidence and associated risk factors. Int Wound J 16: 773–780.
-
35.
Călina D, et al., 2017. Antimicrobial resistance development following surgical site infections. Mol Med Rep 15: 681–688.
-
36.
Girma G, Gebre K, Himanot T, 2013. Multidrug resistant bacteria isolates in infected wounds at Jimma University Specialized Hospitals, Ethiopia. Ann Clin Microbiol Antimicrob 12: 1–7.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 4979 | 4979 | 84 |
| Full Text Views | 79 | 79 | 11 |
| PDF Downloads | 68 | 68 | 8 |