Elemental Profile of Postoperative Infected Wound Exudates in Hospitalized Surgical Patients: A Cross-Sectional Study at People’s Medical College Hospital, Nawabshah
Elemental Profiling of Post-Operative Pyogenic Infections
Keywords:
Elemental, Excudative, Infection, Metal, Surgical, WoundAbstract
Background: Pyogenic infections following surgery are important contributors to post-surgical morbidity and may be related to surgical site and biochemical properties of wound exudates. Pus elemental profiling can give information on the wound microenvironment which can direct individual clinical interventions.
Methods: The study design was analytical cross-sectional with 370 consecutive patients (aged 15-80 years) who had infected postoperative wounds in Peoples Medical College Hospital, Nawabshah, Pakistan, between June 2023 and July 2025. Six gastrointestinal surgical sites were aseptically collected pus/wound-exudates. In the wet digestion, sodium, potassium, magnesium, calcium, zinc, copper and chromium were measured in triplicate by inductively coupled plasma optical emission spectrometry. One-way analysis of variance and independent student’s t-test were used to test the differences by surgical site and age, respectively, and by sex.
Results: The sample comprised 181 males (48.92%) and 189 females (51.08%); 115 patients (31.08%) were aged 61–80 years. Concentrations differed among surgical sites for sodium (p=0.002), magnesium (p=0.001), zinc (p=0.002), copper (p=0.003), and chromium (p=0.004), but not potassium (p=0.104) or calcium (p=0.103). Gut-cancer exudates showed the highest sodium (140.00±7.30 mmol/L), copper (24.00±1.65 µmol/L), and chromium (14.50±1.30 µmol/L). All seven elements were found to be different among the age groups (p=0.001–0.003), all elements except potassium were different by sex.
Conclusion: The work highlights the increased level of sodium, calcium, copper and chromium in the samples of the gut cancer and increased magnesium and zinc in the exudates from the colon and stomach. Significant higher contents of sodium, calcium, copper and chromium are in exudates of females while in males, magnesium and zinc are higher. Sodium, potassium, copper and zinc levels are higher in 61-80 years age group than in other age groups.
References
Leandri M, Vallicelli C, Santandrea G, et al. Postoperative infections after appendectomy for acute appendicitis: the surgeon's checklist. Antibiotics (Basel). 2025;14(9):954. https://doi.org/10.3390/antibiotics14090954
Wenzel RP. Surgical site infections and the microbiome: an updated perspective. Infect Control Hosp Epidemiol. 2019;40(5):590-596. https://doi.org/10.1017/ice.2018.363
Graf PD, et al. Bacterial reservoir in deeper skin is a potential source for surgical site and biomaterial-associated infections. J Hosp Infect. 2023;140:62-71. https://doi.org/10.1016/j.jhin.2023.07.014
Khan FU, Fang Y, Khan Z, et al. Occurrence, associated risk factors, and treatment of surgical site infections in Pakistan: a hospital-based study. Eur J Inflamm. 2020;18:2058739220960547. https://doi.org/10.1177/2058739220960547
Gupta P, Lal P, Manchanda V. Microbial profile from peritoneal fluid and surgical wounds in perforation peritonitis. Postgrad Med J. 2023;99(1171):1-8. https://doi.org/10.1177/00494755221150537
Misha G, Chelkeba L, Melaku TB. 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. 2021;20:33. https://doi.org/10.1186/s12941-021-00440-z
Linju M, Rekha M. Role of inorganic ions in wound healing: an insight into localized delivery approaches. Ther Deliv. 2023;14(10):649-667. https://doi.org/10.4155/tde-2023-0036
Majid E, Pathan S, Zuberi BF, et al. Comparison of honey and povidone iodine dressings in post-cesarean surgical site wound infection healing. Pak J Med Sci. 2023;39(6):1803-1808. https://doi.org/10.12669/pjms.39.6.7499
Arija D, Mirani SH, Abideen ZU, et al. Serum C-reactive protein, procalcitonin, and lactate levels as predictors of postoperative surgical site infections. Pak J Med Health Sci. 2026;20(3):26-32. https://doi.org/10.53350/pjmhs02026203.5
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4(10):e296. https://doi.org/10.1371/journal.pmed.0040296
Lwanga SK, Lemeshow S. Sample Size Determination in Health Studies: A Practical Manual. Geneva: World Health Organization; 1991.
Santos HM, Caires ARL, Lemos VA, et al. Microwave-assisted digestion using diluted HNO₃ and H₂O₂ for multi-element determination in guarana samples by ICP OES. Food Chem. 2019;275:457-463. https://doi.org/10.1016/j.foodchem.2018.09.114
Aghdassi SJS, Schröder C, Gastmeier P. Gender-related risk factors for surgical site infections: results from ten years of surveillance in Germany. Antimicrob Resist Infect Control. 2019;8:95. https://doi.org/10.1186/s13756-019-0547-x
Alemayehu MA, Azene AG, Mihretie KM. Time to development of surgical site infection and its predictors among general surgery patients: a prospective follow-up study. BMC Infect Dis. 2023;23:334. https://doi.org/10.1186/s12879-023-08301-0
Mengistu DA, Alemu A, Abdukadir AA, et al. Global incidence of surgical site infection among patients: systematic review and meta-analysis. Am J Med Sci. 2023;83:104324. https://doi.org/10.1177/00469580231162549
Huda F, Shasheendran S, Basu S, et al. Risk factors of surgical site infection in elective laparotomy in a tertiary care center: an observational study. Int J Burns Trauma. 2022;12(3):106-113.
PakSurg1 investigators. Determining the epidemiology and risk factors of surgical site infections in Pakistan: a multicentre prospective cohort study. BMJ Open. 2023;13(7):e070831. https://doi.org/10.1136/bmjopen-2022-070831
Rezaei AR, Zienkiewicz D, Rezaei AR. Surgical site infections: a comprehensive review. J Trauma Inj. 2025;38(2):71-81. https://doi.org/10.20408/jti.2025.0019
Ansari S, Hassan M, Barry HD, et al. Risk factors associated with surgical site infections: a retrospective report from a developing country. Cureus. 2019;11(6):e4801. https://doi.org/10.7759/cureus.4801
Tahir MI, Waheed MK, Nadeem S, et al. Assessment of surgical site infection rates in emergency versus elective procedures: a cross-sectional study. Ann Pak Med Dent Coll. 2024;1(3):14-19. https://doi.org/10.53350/Annalspakmed.1.3.4
GlobalSurg Collaborative. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective international multicentre cohort study. Lancet Infect Dis. 2018;18(5):516-525. https://doi.org/10.1016/S1473-3099(18)30101-4
Mai K, Maverakis E, Li J, Zhao M. Maintaining and restoring gradients of ions in the epidermis: the role of ion and water channels in acute cutaneous wound healing. Adv Wound Care (New Rochelle). 2023;12(12):780-792. https://doi.org/10.1089/wound.2022.0128
Hou HT, Xue LG, Zhou JY, et al. Alteration of plasma trace elements during and after coronary artery bypass grafting surgery. J Trace Elem Med Biol. 2020;62:126612. https://doi.org/10.1016/j.jtemb.2020.126612
Dixit R, Chaudhary NK, Mishra PK, et al. Study on blood serum levels of heavy and trace metals in chronic non-healing wounds. Integr Cancer Ther. 2022;23:15347346221074161. https://doi.org/10.1177/15347346221074161
Dalisson B, Barralet J. Bioinorganics and wound healing. Adv Healthc Mater. 2019;8(18):1900764. https://doi.org/10.1002/adhm.201900764
Mukherjee K, Kavalukas SL, Barbul A. Nutritional aspects of gastrointestinal wound healing. Adv Wound Care (New Rochelle). 2016;5(11):507-515. https://doi.org/10.1089/wound.2015.0671
Long DR, Bryson-Cahn C, Waalkes A, et al. Contribution of the patient microbiome to surgical site infection and antibiotic prophylaxis failure in spine surgery. Sci Transl Med. 2024;16(742):eadk8222. https://doi.org/10.1126/scitranslmed.adk8222
Zwicky SN, Gloor S, Tschan F, et al. No impact of sex on surgical site infections in abdominal surgery: a multi-center study. Langenbecks Arch Surg. 2022;407(8):3763-3769. https://doi.org/10.1007/s00423-022-02691-6
Voruganti VS, Klein GL, Lu HX, et al. Impaired zinc and copper status in children with burn injuries: need to reassess nutritional requirements. Burns. 2005;31(6):711-716. https://doi.org/10.1016/j.burns.2005.04.026
Lansdown ABG. Sequential changes in trace metal, metallothionein, and calmodulin concentrations in healing skin wounds. J Anat. 1999;195(3):375-386. https://doi.org/10.1046/j.1469-7580.1999.19530375.x
Sirkka T, Skiba JB, Apell SP. Wound pH depends on actual wound size. arXiv. 2016. https://arxiv.org/abs/1601.06365
Linju MC, Rekha MR. Role of inorganic ions in wound healing: insights into localized delivery approaches. Ther Deliv. 2023;14(10):649-667. https://doi.org/10.4155/tde-2023-0036
Adjepong D, Jahangir S, Malik BH. The effect of zinc on post-neurosurgical wound healing: a review. Cureus. 2020;2(1):e6770. https://doi.org/10.7759/cureus.6770
Salvo J, Sandoval C. Role of copper nanoparticles in wound healing for chronic wounds: literature review. Burns Trauma. 2022;10:tkab047. https://doi.org/10.1093/burnst/tkab047
Tabriz N, Fried D, Uslar V, Weyhe D. Impact of preoperative calcium and magnesium supplementation on quality of life and hypocalcemia post-thyroidectomy. Endocrinol Diabetes Metab. 2026;9(1):e70129. https://doi.org/10.1002/edm2.70129
Ranire-Maguire M, Caprioli R, Taylor C, Rodger R, Thomas A, Oropallo A. Exudate management with a next-generation multilayered foam dressing in traumatic and surgical wounds: a prospective multicentre study. J Wound Care. 2026;35:392-398. https://doi.org/10.12968/jowc.2026.0048
Palmieri B, Vadalà M, Laurino C. Nutrition in wound healing: investigation of the molecular mechanisms, a narrative review. J Wound Care. 2019;28(10):683-693. https://doi.org/10.12968/jowc.2019.28.10.683
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