OBJECTIVES: To conduct a systematic review of literature on the epidemiological and economic burden of surgical site infection (SSI) in India.  METHODS: A literature search of the EMBASE and Medline databases was conducted. The search was limited to 1995–2010 to ensure the pertinence of the data. Searches to identify epidemiological and economic studies were conducted separately. Relevant studies were identified using pre-defined criteria (i.e., reports the rate, risk factors, cost of SSI; conducted in a hospital setting; not an intervention study). RESULTS: Twelve studies met the inclusion criteria and are presented in this review. The overall incidence of SSI in India is approximately 10%. The rates of SSI varied depending on the surveillance period, data collection method, and surgical procedure. The incidence of SSI was high for cardiovascular (5–18%) and gastrointestinal (6–16%) surgery. The rates of SSI appeared lower for neurosurgery (0.8–2.5%), although those studies only considered SSI cases before discharge from hospital. Diabetes and obesity were found to increase the risk of SSI by over 70%. Other significant risk factors identified include surgery duration and wound classification. The most common pathogens in SSIs were Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. SSIs were found to extend hospital stay by 5–18 days and increase treatment cost by 4–30%. The estimated cost of hospitalisation was significantly higher in patients with SSI compared to patients without SSI (29,000 vs. 16,000 rupees, P<0.001). CONCLUSIONS: In India, where an estimated 72% of health care expense is out-of-pocket, the additional cost associated with SSI (treatment, loss of ability to work) represents a significant burden to patients and their families. The increase in hospital stay also lays additional burden to an already resource-constrained health care system. Interventions aimed at reducing SSI would provide cost-savings and improve the efficiency of the health care system.