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. 2025 Mar 13;14(1):22.
doi: 10.1186/s13756-025-01537-2.

High incidence of multidrug-resistant organisms and modifiable risk factors associated with surgical site infections: a cohort study in a tertiary medical center in Kuala Lumpur, Malaysia from 2020 to 2023

Anis Najwa Muhamad  1 , Cindy Shuan Ju Teh  2 , Mohd Rusdi Draman  3 , Yohan Khirusman Adnan  3 , Azlina Amir Abbas  3 , Tak Loon Khong  4 , Vairavan Narayanan  4 , Soo Nee Tang  1 , Rina Karunakaran  1 , Norhafizah Ab Manan  5 , Anjanna Kukreja  6 , Siti Zuhairah Mohamad Razali  6   7 , Chun Yoong Cham  4 , Robert D Hontz  8 , Michael J Gregory  8 , Anca Selariu  8 , Huy C Nguyen  8 , Andrew G Letizia  8 , Sasheela Sri La Sri Ponnampalavanar  9   10
Affiliations

High incidence of multidrug-resistant organisms and modifiable risk factors associated with surgical site infections: a cohort study in a tertiary medical center in Kuala Lumpur, Malaysia from 2020 to 2023

Anis Najwa Muhamad et al. Antimicrob Resist Infect Control. .

Abstract

Background: Surgical site infections (SSIs) are a persistent challenge in healthcare, contributing significantly to patient morbidity, mortality, and healthcare costs. Despite advancements in preventive measures, SSIs remain prevalent, especially in countries like Malaysia where rates are higher than in high-income nations.

Methods: A prospective, cohort study was conducted at the University Malaya Medical Center (UMMC), Malaysia, from November 2020 to May 2023. Clinical and microbiological data were collected, and logistic regression were performed to identify risk factors associated with SSIs.

Results: A total of 1,815 patients undergoing orthopedic, neurosurgical, and general surgical procedures were monitored for SSIs. The incidence rate of SSIs was 3.23 per 100 procedures (n = 71) with significant associations observed between SSI occurrence and prolonged surgical duration > 100 min, extended hospitalization > 5 days, trauma-to-surgery interval > 8 days, and presence of implants. Common pathogens isolated included Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Multidrug-resistant organisms (MDROs) were identified in 42.1% of the total isolates.

Conclusions: In this study, a high rate of MDRO and risk factors for SSI were identified. It emphasises the need for ongoing surveillance to guide infection prevention strategies and antimicrobial stewardship programs. Future research should prioritize evaluating the impact of targeted interventions tailored to identified risk factors to optimize surgical patient outcomes.

Keywords: Antimicrobial resistance; Multidrug-resistant organisms; Surgical site infection.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Medical Research Ethics Committee (MREC) of the University Malaya Medical Centre (UMMC) on 13 July 2020 (MREC-ID No.: 2020616-8769) in compliance with all applicable federal regulations governing the protection of human subjects. Extramural research review was conducted following the U.S. Navy Human Research Protection Program guidelines (HPRO.NAMRU2.2019.0009). All research activities conformed to the principles embodied in the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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