Association of Multidrug-Resistant Bacterial Infections with Histopathological Severity, Antibiotic Outcomes, and Community-Level Risk Factors in Surgical Wound Infections

Abstract

Background: Multidrug-resistant (MDR) organisms increasingly complicate surgical wound infections and may worsen tissue damage, delay healing, and reduce antibiotic effectiveness.

Objective: To determine the association of MDR bacterial infections with histopathological severity, antibiotic outcomes, and community-level risk factors in surgical wound infections.

Methods: This cross-sectional analytical study included 120 patients with surgical wound infections from January 2024 to January 2025 at the Department of Pathology, Khawaja Muhammad Safdar Medical College, Sialkot, Pakistan, in collaboration with the Department of Microbiology, Sharif Medical and Dental College, Lahore, Pakistan. Wound specimens were cultured, antibiotic susceptibility was assessed, and tissue samples were examined histopathologically. Clinical outcomes and risk factors were analyzed.

Results: MDR bacterial infection was identified in 68 patients (56.7%), while 52 patients (43.3%) had non-MDR infection. MDR infection was significantly associated with diabetes mellitus (50.0% vs 23.1%; p=0.003), prior antibiotic use (66.2% vs 25.0%; p<0.001), delayed presentation (58.8% vs 25.0%; p<0.001), poor hygiene (55.9% vs 21.2%; p<0.001), and previous hospitalization (45.6% vs 19.2%; p=0.003). Severe histopathological involvement was more frequent in MDR cases than non-MDR cases (41.2% vs 13.5%; p=0.001). MDR infections showed lower favorable antibiotic response (38.2% vs 76.9%; p<0.001), higher repeat debridement (42.6% vs 15.4%; p=0.001), and longer hospital stay (9.6 ± 3.4 vs 6.1 ± 2.7 days; p<0.001).

Conclusion: MDR surgical wound infections were common and were associated with severe tissue injury, poor antibiotic response, and adverse clinical outcomes.