{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T06:07:12Z","timestamp":1771049232661,"version":"3.50.1"},"reference-count":38,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"German Academic Exchange Service","award":["81248133"],"award-info":[{"award-number":["81248133"]}]},{"name":"German Ministry of Economic Cooperation and Development","award":["01KA1921B"],"award-info":[{"award-number":["01KA1921B"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: Surgical site infections (SSIs) are healthcare-associated infections that can occur following surgical procedures, either at admission or within 30 days post-discharge. This study aimed to assess the incidence and associated risk factors for superficial SSI at a Tertiary Hospital in Ethiopia. Methods: A longitudinal study was conducted among patients undergoing surgery at Jimma University Specialized and Comprehensive Hospital (JUSCH) from 1 June to 30 September 2022. Pus, wound swab, or abscess samples were inoculated on Blood and MacConkey Agar for culture. Bacterial isolates were identified using MALDI-TOF, antimicrobial susceptibility testing was performed using the Kirby\u2013Bauer disc diffusion method, and the results were interpreted according to EUCAST 2022 breakpoints. Incidence rates, Kaplan\u2013Meier analysis, extended Cox regression, and violin plots were utilized to analyze and present the findings. Results: Among 1205 participants, 629 (52.2%) were male, and the median age was 27 years (IQR: 16\u201340). The incidence of SSI was 9.2 per 1000 person-days. Most SSIs occurred during hospitalization (81.1%), and the remaining primarily developed within the first week post-discharge. The culture positivity rate was 72.7%, yielding 252 isolates comprising 36 bacterial species. The most frequently identified organisms were E. coli (22.2%), Acinetobacter (20.2%), and Klebsiella (14.7%). Over 67% of Gram-negative bacteria were ESBL producers. Age, gender, residence, hospital ward, surgery area, emergency surgery, longer hospitalization, and the number of staff attending the surgery were identified as important risk factors. Conclusions: This study revealed a high incidence of SSI during hospitalization, with significant proportion identified post-discharge. The high rates of multidrug-resistant Gram-negative pathogens underscore the urgent need for comprehensive infection prevention and control measures.<\/jats:p>","DOI":"10.3390\/antibiotics15020201","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T12:05:46Z","timestamp":1770897946000},"page":"201","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Epidemiology of Surgical Site Infections: Incidence and Risk Factors at Jimma University Specialized and Comprehensive Hospital, Ethiopia"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2299-7863","authenticated-orcid":false,"given":"Mulatu","family":"Gashaw","sequence":"first","affiliation":[{"name":"School of Medical Laboratory Sciences, Jimma University, Jimma P.O. Box 378, Ethiopia"},{"name":"CIH<sup>LMU<\/sup> Center for International Health, University Hospital, LMU Munich, Leopoldstrasse 5, 80802 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8842-6999","authenticated-orcid":false,"given":"Bikila","family":"Alemu","sequence":"additional","affiliation":[{"name":"School of Medical Laboratory Sciences, Jimma University, Jimma P.O. Box 378, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8703-9228","authenticated-orcid":false,"given":"Andreas","family":"Wieser","sequence":"additional","affiliation":[{"name":"Institute of Infectious Disease and Tropical Medicine, LMU University Hospital, 80802 Munich, Germany"},{"name":"Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology, Infection and Pandemic Research IIP, T\u00fcrkenstra\u00dfe 87, 80799 Munich, Germany"},{"name":"German Center for Infection Research (DZIF), 80802 Munich, Germany"},{"name":"Max von Pettenkofer-Institute, Medical Faculty, Ludwig Maximilian University of Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahel","family":"Tamrat","sequence":"additional","affiliation":[{"name":"School of Medical Laboratory Sciences, Jimma University, Jimma P.O. Box 378, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3289-3355","authenticated-orcid":false,"given":"Assefa Legesse","family":"Sisay","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Jimma University, Jimma P.O. Box 378, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1616-0212","authenticated-orcid":false,"given":"Kira","family":"Elsbernd","sequence":"additional","affiliation":[{"name":"Institute of Infectious Disease and Tropical Medicine, LMU University Hospital, 80802 Munich, Germany"},{"name":"Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8583-4324","authenticated-orcid":false,"given":"Rebecca","family":"Kisch","sequence":"additional","affiliation":[{"name":"Institute of Infectious Disease and Tropical Medicine, LMU University Hospital, 80802 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gemechu","family":"Abera","sequence":"additional","affiliation":[{"name":"Department of Surgery, Jimma University, Jimma P.O. Box 378, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4116-7355","authenticated-orcid":false,"given":"Gersam","family":"Abera","sequence":"additional","affiliation":[{"name":"Department of Surgery, Jimma University, Jimma P.O. Box 378, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Demisew Amenu","family":"Sori","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Jimma University, Jimma P.O. Box 378, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6264-9695","authenticated-orcid":false,"given":"Esayas Kebede","family":"Gudina","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Jimma University, Jimma P.O. Box 378, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3569-9176","authenticated-orcid":false,"given":"Arne","family":"Kroidl","sequence":"additional","affiliation":[{"name":"CIH<sup>LMU<\/sup> Center for International Health, University Hospital, LMU Munich, Leopoldstrasse 5, 80802 Munich, Germany"},{"name":"Institute of Infectious Disease and Tropical Medicine, LMU University Hospital, 80802 Munich, Germany"},{"name":"German Center for Infection Research (DZIF), 80802 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/S0195-6701(08)60017-1","article-title":"Surgical site infections: Epidemiology, microbiology and prevention","volume":"70","author":"Owens","year":"2008","journal-title":"J. Hosp. Infect."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.jhin.2023.05.019","article-title":"Global incidence of surgical site infections following caesarean section: A systematic review and meta-analysis","volume":"139","author":"Sepidarkish","year":"2023","journal-title":"J. Hosp. Infect."},{"key":"ref_3","first-page":"41","article-title":"Surgical site infections\u2014Review of current knowledge, methods of prevention","volume":"91","year":"2018","journal-title":"Pol. Przegl. Chir."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Peisl, S., Guillen-Ramirez, H., S\u00e1nchez-Taltavull, D., Widmer, A., Sommerstein, R., and Beldi, G. (2024). Influence of patient characteristics on microbial composition in surgical-site infections: Insights from national surveillance study. Br. J. Surg., 111.","DOI":"10.1093\/bjs\/znae138"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1089\/sur.2006.7.s1-7","article-title":"Risk factors for surgical site infection","volume":"7","author":"Cheadle","year":"2006","journal-title":"Surg. Infect."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1089\/sur.2018.125","article-title":"Treating Surgical Infections in Low- and Middle-Income Countries: Source Control, Then What?","volume":"20","author":"Rickard","year":"2019","journal-title":"Surg. Infect."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1016\/j.idc.2021.07.006","article-title":"Surgical Site Infections","volume":"35","author":"Seidelman","year":"2021","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1186\/s12941-023-00643-6","article-title":"Bacterial profile of surgical site infection and antimicrobial resistance patterns in Ethiopia: A multicentre prospective cross-sectional study","volume":"22","author":"Worku","year":"2023","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1002\/vms3.1073","article-title":"Does colonization with MRSA, ESBL\u2014Producing Enterobacteriaceae, and\/or Acinetobacter baumannii\u2014Increase the risk for postoperative surgical site infection?","volume":"9","author":"Gehlen","year":"2023","journal-title":"Vet. Med. Sci."},{"key":"ref_10","first-page":"101046","article-title":"Prevention of surgical site infections in low-income and middle-income countries: When more is not better","volume":"41","author":"Boisson","year":"2022","journal-title":"Anaesth. Crit. Care Pain Med."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Sandberg, C.E.J., Knight, S.R., Qureshi, A.U., and Pathak, S. (2019). Using Telemedicine to Diagnose Surgical Site Infections in Low- and Middle-Income Countries: Systematic Review. JMIR mHealth uHealth, 7.","DOI":"10.2196\/preprints.13309"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Ketema, D.B., Wagnew, F., Assemie, M.A., Ferede, A., Alamneh, A.A., Leshargie, C.T., Kibret, G.D., Petrucka, P., Telayneh, A.T., and Alebel, A. (2020). Incidence and predictors of surgical site infection following cesarean section in North-west Ethiopia: A prospective cohort study. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-05640-0"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1097\/MS9.0000000000000411","article-title":"Predictors of surgical site infection among women following cesarean delivery in eastern Ethiopia: A prospective cohort study","volume":"85","author":"Adane","year":"2023","journal-title":"Ann. Med. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/01.ASW.0000722760.27083.3c","article-title":"Risk Factors for Surgical Site Infection after Minor Dermatologic Surgery","volume":"34","author":"Delpachitra","year":"2021","journal-title":"Adv. Skin Wound Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1001\/jamasurg.2019.0569","article-title":"Association of Duration and Type of Surgical Prophylaxis with Antimicrobial-Associated Adverse Events","volume":"154","author":"Strymish","year":"2019","journal-title":"JAMA Surg."},{"key":"ref_16","unstructured":"NIHR Global Research Health Unit on Global Surgery (2022). Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh): A pragmatic, cluster-randomised trial in seven low-income and middle-income countries. Lancet, 400, 1767\u20131776."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1111\/ajo.13519","article-title":"Reducing post-caesarean infection in the Kimberley region of Western Australia: An audit-based observational study","volume":"63","author":"Sekhon","year":"2023","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_18","unstructured":"(2024, April 03). Jimma University Medical Center. Available online: https:\/\/ju.edu.et\/jimma-medical-center\/."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.2147\/IJWH.S425632","article-title":"Incidence, Bacterial Profile and Predictors of Surgical Site Infection After Cesarean Section in Ethiopia, A Prospective Cohort Study","volume":"15","author":"Mezemir","year":"2023","journal-title":"Int. J. Womens Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"Magiorakos","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_21","first-page":"141","article-title":"Pattern of pathogens and their sensitivity isolated from surgical site infections at the Aga Khan University Hospital, Nairobi, Kenya","volume":"23","author":"Dinda","year":"2013","journal-title":"Ethiop. J. Health Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s13037-017-0131-3","article-title":"Surgical site infection and its associated factors following cesarean section: A cross sectional study from a public hospital in Ethiopia","volume":"11","author":"Gelaw","year":"2017","journal-title":"Patient Saf. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Legesse Laloto, T., Hiko Gemeda, D., and Abdella, S.H. (2017). Incidence and predictors of surgical site infection in Ethiopia: Prospective cohort. BMC Infect. Dis., 17.","DOI":"10.1186\/s12879-016-2167-x"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s13037-017-0138-9","article-title":"Risk factors for surgical site infections in obstetrics: A retrospective study in an Ethiopian referral hospital","volume":"11","author":"Mamo","year":"2017","journal-title":"Patient Saf. Surg."},{"key":"ref_25","first-page":"635","article-title":"Antimicrobial Resistance Profile of Bacterial Isolates Identified from Surgical Site Infections at a Referral Hospital, Northwest Ethiopia","volume":"31","author":"Abosse","year":"2021","journal-title":"Ethiop. J. Health Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"102247","DOI":"10.1016\/j.amsu.2021.102247","article-title":"Incidence, risk factors and outcomes of surgical site infections among patients admitted to Jimma Medical Center, South West Ethiopia: Prospective cohort study","volume":"65","author":"Misha","year":"2021","journal-title":"Ann. Med. Surg."},{"key":"ref_27","first-page":"18","article-title":"Aerobic bacterial isolates from post-surgical wound and their antimicrobial susceptibility pattern: A hospital based cross-sectional study","volume":"3","author":"Dessalegn","year":"2014","journal-title":"E3 J. Med. Res."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Mengesha, R.E., Kasa, B.G., Saravanan, M., Berhe, D.F., and Wasihun, A.G. (2014). Aerobic bacteria in post surgical wound infections and pattern of their antimicrobial susceptibility in Ayder Teaching and Referral Hospital, Mekelle, Ethiopia. BMC Res. Notes, 7.","DOI":"10.1186\/1756-0500-7-575"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.jhin.2018.05.017","article-title":"High carriage rate of extended-spectrum beta-lactamase-producing Enterobacteriaceae among patients admitted for surgery in Tanzanian hospitals with a low rate of endogenous surgical site infections","volume":"100","author":"Moremi","year":"2018","journal-title":"J. Hosp. Infect."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1089\/sur.2019.142","article-title":"Surgical Infections in Low- and Middle-Income Countries: A Global Assessment of the Burden and Management Needs","volume":"21","author":"Rickard","year":"2019","journal-title":"Surg. Infect."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s13037-020-00232-y","article-title":"Surgical site infection and pathogens in Ethiopia: A systematic review and meta-analysis","volume":"14","author":"Birhanu","year":"2020","journal-title":"Patient Saf. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Gashaw, M., Gudina, E.K., Tadesse, W., Froeschl, G., Ali, S., Seeholzer, T., Kroidl, A., and Wieser, A. (2024). Hospital Wastes as Potential Sources for Multi-Drug-Resistant ESBL-Producing Bacteria at a Tertiary Hospital in Ethiopia. Antibiotics, 13.","DOI":"10.3390\/antibiotics13040374"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e288","DOI":"10.1016\/S1473-3099(16)30402-9","article-title":"New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: An evidence-based global perspective","volume":"16","author":"Allegranzi","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"515","DOI":"10.2147\/IJGM.S253216","article-title":"Key Issues Surrounding Appropriate Antibiotic Use for Prevention of Surgical Site Infections in Low- and Middle-Income Countries: A Narrative Review and the Implications","volume":"14","author":"Mwita","year":"2021","journal-title":"Int. J. Gen. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s13017-020-0288-4","article-title":"Intraoperative surgical site infection control and prevention: A position paper and future addendum to WSES intra-abdominal infections guidelines","volume":"15","author":"Sartelli","year":"2020","journal-title":"World J. Emerg. Surg."},{"key":"ref_36","first-page":"224","article-title":"Prevention of surgical site infections in orthopaedic surgery: A synthesis of current recommendations","volume":"23","author":"Tucci","year":"2019","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_37","unstructured":"World Health Organization (2018). Protocol for Surgical Site Infection Surveillance with a Focus on Settings with Limited Resources."},{"key":"ref_38","unstructured":"European Committee on Antimicrobial Susceptibility Testing (2024, April 03). Breakpoint Tables for Interpretation of MICs and Zone Diameters Version 12.0, Valid from 2022-01-01. Available online: https:\/\/www.eucast.org\/fileadmin\/src\/media\/PDFs\/EUCAST_files\/Breakpoint_tables\/v_12.0_Breakpoint_Tables.pdf."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/2\/201\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T05:18:53Z","timestamp":1771046333000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/2\/201"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,12]]},"references-count":38,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["antibiotics15020201"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics15020201","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,12]]}}}