Background: Surgical Site Infection (SSI) is one of the major hospital acquired infections, highly associated with prolonged hospitalisation, morbidity and mortality. In open urological surgeries, little is known on magnitude and factors associated with development of SSI. Methods and Materials: The intervention was a cross-sectional prospective observational study performed between August 2015 and March 2016 at Muhimbili National hospital (MNH), Dar es Salaam, Tanzania. Patients who underwent open urological surgery at MNH during the study period and met inclusion criteria were consecutively enrolled, and followed up for 30 days. Patients´ and operative characteristics were recorded using standard structured questionnaires. Wound/ pus swabs were collected from patients with clinical evidence of SSI for bacteriological processing. Data analysis was performed using SPSS version 20. Results: Of 182 patients who underwent open urological surgery, 22% (40/182) developed SSI. Pre-operative urinary tract infection (aOR 9.73, 95%CI 3.93-24.09, p<.001) and contaminated wound class (aOR 24.997, 95%CI 2.58-242.42, p = .005) were independent predictors for development of SSI. Shaving within 30 hrs before surgical procedure was found to be protective for developing SSI (aOR 0.26, 95%CI 0.09-0.79, p=.02). Escherichia coli (20/40) was the most predominant pathogen in SSI followed by Klebsiella pneumoniae (7/40) and S. aureus (6/40). Gram-negative bacteria were highly resistant to ceftriaxone, gentamicin, amoxicillin-clavulanic acid and trimethoprim-sulfamethoxazole. Conclusion: Surgical Site Infection was high in open urological interventions. Pre-operative urinary tract infection and contaminated wound class predicted SSI. Bacteria causing SSI were highly resistant to commonly used antibiotics.

Abstract:The importance of an ultrasound in diagnosis of bladder tumours has been investigated by different authors. Some have questioned its effectiveness while others have considered the technique to be an important tool in the initial evaluation of bladder tumours. This study was carried out to establish the effectiveness of the ultrasound in diagnosis of bladder tumours at the Muhimbili National Hospital in Dar es Salaam, Tanzania. Clinical indications and ultrasound findings were recorded. Cystoscopy was done and findings recorded on a preformed questionnaire. The ultrasound findings were compared to cystoscopy findings and the sensitivity, negativity, positive predictive value and negative predictive value determined. A total of 110 patients were recruited in this study and the male to female ratio was 2:1. The commonest (37%) age group was 41-60 years. The most common clinical indication overall was haematuria in 37% of all cases. In males, bladder outlet obstruction due to stricture was the commonest indication (31%). Out of 110 patients scheduled for cystoscopy, 71 had ultrasound done preoperatively. In these patients 70% had some form of abnormal ultrasound findings. The sensitivity, specificity, positive predictive value, and the negative predictive value (NPV) of ultrasound in detection of bladder tumour were 83%, 93%, 89% and 89%, respectively. In conclusion, ultrasound is an effective method for evaluating patients presenting with haematuria or suspected to have bladder tumours. It is cheap, available, affordable and non-invasive; has a high sensitivity, and therefore it can also be useful in the follow-up of patient with bladder cancer. ________________________________________________________________________________

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Background Surgical site infection (SSI) is one of the major hospital acquired infections highly associated with prolonged hospitalization, morbidity and mortality. In open urological surgeries, little is known on magnitude and factors associated with development of SSI. Methods and Materials This was a cross-sectional prospective observational study performed between August 2015 and March 2016 at Muhimbili National hospital (MNH), Dar es Salaam, Tanzania. All patients who underwent open urological surgery and met inclusion criteria were consecutively enrolled, and followed up for 30 days. Patients´ and operative characteristics were recorded using standard structured questionnaires. Wound/ pus swabs were collected from patients with clinical evidence of SSI for bacteriological processing. Data analysis was performed using SPSS version 20. Results Of 182 patients who underwent open urological surgery, 22% developed SSI. Pre-operative urinary tract infection (aOR 9.73, 95%CI 3.93-24.09, p<0.001) and contaminated wound class (aOR 24.997, 95%CI 2.58-242.42, p = 0.005) were independent predictors for development of SSI. Shaving within 30 hrs before surgical procedure was found to be protective for developing SSI (aOR 0.26, 95%CI 0.09-0.79, p = 0.02). Escherichia coli (20/40) was the most predominant pathogen in SSI followed by Klebsiella pneumoniae (7/40) and S. aureus (6/40). Gram-negative bacteria were highly resistant to ceftriaxone, gentamicin, amoxicillin-clavulanic acid and trimethoprim-sulfamethoxazole. Conclusion SSI was high in open urological interventions. Pre-operative urinary tract infection and contaminated wound class predicted SSI. Bacteria causing SSI were highly resistant to commonly used antibiotics.

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