Multidrug-resistant surgical site infections in a humanitarian surgery project

Abstract

The epidemiology of surgical site infections (SSIs) in surgical programmes in sub-Saharan Africa is inadequately described. We reviewed deep and organ-space SSIs occurring within a trauma project that had a high-quality microbiology partnership and active follow-up. Included patients underwent orthopaedic surgery in Teme Hospital (Port Harcourt, Nigeria) for trauma and subsequently developed a SSI requiring debridement and microbiological sampling. Data were collected from structured chart reviews and programmatic databases for 103 patients with suspected SSI [79% male, median age 30 years, interquartile range (IQR) 24-37]. SSIs were commonly detected post-discharge with 58% presenting >28 days after surgery. The most common pathogens were: Staphylococcus aureus (34%), Pseudomonas aeruginosa (16%) and Enterobacter cloacae (11%). Thirty-three (32%) of infections were caused by a multidrug-resistant (MDR) pathogen, including 15 patients with methicillin-resistant S. aureus. Antibiotics were initiated empirically for 43% of patients and after culture and sensitivity report in 32%. The median number of additional surgeries performed in patients with SSI was 5 (IQR 2-6), one patient died (1%), and amputation was performed or recommended in three patients. Our findings suggest the need for active long-term monitoring of SSIs, particularly those associated with MDR organisms, resulting in increased costs for readmission surgery and treatment with late-generation antibiotics.

Antibiotics in Prevention and Treatment of Multi-Drug Resistant (MDR) Organisms causing Surgical Site Infection (SSI)

“…In addition, a study done in Nigeria 19 found 32% MDR and staphylococcus aureus as the most common organism associated with SSIs. The reason for this variation in results could probably be due to differences in the antibiotic protocol being followed and hygienic measures in that particular hospital.…”

Prevalence, Diagnosis and Local Susceptibility of Staphylococci Infections

“…In intensive care unit of a Nigerian hospital, out of 71 patients with healthcare-associated infection, bloodstream and urinary tract infections were the commonest infections, and S. aureus was the commonest cause of bloodstream infection with 80% of the S. aureus being MRSA [26]. In surgical site infections for 103 patients with orthopedic surgery in a hospital in Port Harcourt, Nigeria, the commonest pathogen was S. aureus (34%) including 15 patients with MRSA [27]. and prevalence of MRSA with mecA gene as 42.3% from 156 S. aureus in clinical isolates from South Western Nigeria with domination of SCCmec II and SCCmec V [28].…”

Resistance of nosocomial strains to antibacterial drugs and its link to biofilm formation

“…Але перше місце в етіологічній структурі внутрішньолікарняних інфекцій посідають бактеріальні агенти: ентерококи, Streptococcus spp., Staphylococcus spp., Acinetobacter spp., Bacillus cereus, Legionella spp., представники родини Enterobacteriaceae (Proteus mirablis, Klebsiella pneumoniae, Escherichia coli, Serratia marcescens). Найголовніша роль у виникненні внутрішньолікарняних інфекцій, за даними всесвітньої статистики, належить Pseudomonas aeruginosa та Staphylococcus аureus (Abdallah et al, 2014;Khan et al, 2015;Murphy et al, 2016).…”

“…Моніторинг резистентності до антибактеріальних препаратів нозокоміальних штамів мікроорганізмівобов'язкова складова системи інфекційного контролю багатьох країн світу (Murphy et al, 2016;Choi et al, 2016;Iliyasu et al, 2016;Ramirez-Blanco et al, 2017;.…”