Nosocomial infectionshave frequently been reported by several hospitals worldwide. A patient infected with such infections is presented with complaint of fever, inflammation, redness and pus. These infections are also called post-surgical or surgical site infections and a suitable antibiotic therapy can be used to cure these infections(Soriano et al. 2006).Nosocomial infections occur in patients with in 2 days of admittance in hospital three days of liberation or 30 days of incision, it causes increase in hospital stay in infected patients (Inweregbu et al.2013). Surgical site infections including urinary tract infection and pneumonia are most common hospital acquired infections and are caused by bacteria, viruses and fungus (Timsitet al.2012).
These infections occur up to thirty days after surgery (Owenset al.2008). Surgical Site infections increase the rate of morbidity and mortality among surgically operated individuals (Powell et al. 2005).Controllingfactors for these infections includesage, gender, prophylactic administration of antibiotics and aseptic procedures(Lavallee et al. 2014).
There are number of risk factors in development of hospoital acquired infections. Obesity is also an important risk factor in developing post operative infections and is directly associated with under dosage of antibiotic given prophylactically (Hunttunen et al.2013). Surgeon should be aware of antibiotic choice, dose and duration based on reliable guidelines for prophylaxis to avoid common type of adverse effects on surgical sites (Rafati et al. 2014).
Motie et al. (2014) found that there was an inverse relation between length of surgical incision and rate of surgical infections it was found that type of surgery is main risk factor in developing of infections. The most commonly prescribed antibiotics were combination of ceftriaxone and metronidazole (51.6%).The contaminated and clean contaminated wounds are associated with higher rate of surgical site infections.
Post-surgical infections are known to major health issue, that are responsible for high treatment cost, more readmission in hospitals, increased stay in hospital and increase in rate of infections and even death of surgically operated patient (Mengesha et al. 2014). The rate of occurrence increases due to use of mini sterile gloves, operating costumes, face masks and other specific surgical coverings in operating rooms (Salassa and Swiontkowski 2014).
Both Gram positive and Gram negative species of bacteria are responsible in causing such infections and most common isolates obtained from pus areStaphylococcusepidermidis, Staphylococcus aureus, Proteus vulgaris,Pseudomonas aeruginosa, Klebsiella pneumonia, Proteus mirabillis, Escherichia coli etc.Post surgical abdominal infections are more common after abdominal surgeries. But the disclosure of these infections in early stage is considerably difficult in old age patients along the condition of hyperthermia and increased level of C reactive protein are visible sign in such type of infections (Lin et al. 2002).A variety of natural and synthetic antibiotics are used to treat infections. Ascorbic acid, zinc and garlic are useful in killing bacteria, improving immunity and thus preventing diseases.The most important thing about these antibiotics is that these are less toxic and less harmful thus can be used in pregnant women reducing the chance of urinary tract infections. Also the intake of 100mg ascorbic acid or vitamin c as important vitamin in balanced diet daily causes improvement of health in pregnant women(Ochoa et al. 2007).
There is much rapid increase in morbidity and mortality in postpartum women day by day although many antibiotics are used peri operatively along with other precautions and preventive measures. So obstetricians are facing a lot of complications in operatingmany caesarean deliveries (Haas et al. 2014).
The usage of appropriate antibiotics peri operatively for prophylaxis along following withan appropriate aseptic procedure before, during and after surgery proved effective in controlling these infections (Michalopoulos and Sparos 2002).
Optimal dosage and duration while administration of prophylactic antibiotics to patients must be considered because use of antibiotic for inappropriate duration of time can result in increased risk of post-operative brain infections (Wu et al. 2013).A large number of cephalosporins speciallyof second generationhave been proved very effective in reduction of development of post-operative infections but dosage and duration of these antibiotics varied from patient to patient (Gelijns et al. 2014).Intra-abdominal pus can be reduced by the correct use of antibiotics and by following sterile procedures (Romano et al. 2014).Cephalosporins are useful for eradication of pathogens of skin like Staphylococcus aureus. An antibiotic cefazolin belonging to first generation antibiotics plays major role against pathogens in many clean wound incisions (Page et al.1993).
In field of gynaecology surgery some antibiotics are also prescribed in combinations and thus proved more efficacious (Bratzler et al. 2013). Ceftriaxone from the group of third generation cephalosporins given before surgery was as useful in prevention of major pelvic infections and urinary tract infections as compared to three doses of cefazolin given over 14 hours peri operatively (Hemsell et al. 1984).
Ascorbic acid is a potentantioxidant which markedly reduced the growth of E.coli, Pseudomonas aeruginosa and Staphylococcusand it provided significant effectiveness in combination with levofloxacin (Carlssonet al.2005).Ascorbic acid increases wound healing, immune system activation, collagen formation due to its oxidative property.Alsonutritional deficiencies decreases wound healing after surgeries (MacKay and Miller 2003).Ascorbic acid inhibits the growth of Stayphylococusaureus bacteria by producing oxidative radical thus increasing the oxidative stress,affecting the metabolism and inhibiting the growth of bacteria invitro(Kallio et al. 2012).
The use of ascorbic acid with antibiotics is significant, high doses of ascorbic acid with antibiotics have shown synergistic effects and resulted in prevention of life threating diseases thus high potency vitamin supplementation can reduce morbidity and speed recovery (Ishida et al.1998).
The aim of this study project is to identify the prevalence of microbes involved inpost-operative infections and also to determine the sensitivity patterns of isolated pathogens by using culture sensitivity test against most commonly prescribed antibiotic (ceftriaxone) alone and in combination with ascorbic acid (vitamin C) in vitro.