Surgical Infections in Low- and Middle-Income Countries: A Global Assessment of the Burden and Management Needs

Abstract

Background: The burden of surgical infections in low-and middle-income countries (LMICs) remains poorly defined compared with high-income countries. Although there are common infections necessitating surgery prevalent across the world, such as appendicitis and peptic ulcer disease, other conditions are more localized geographically. To date, comprehensive assessment of the burden of surgically treatable infections or sequelae of surgical infections in LMICs is lacking. Methods: We reviewed the literature to define the burden of surgical infections in LMICs and characterize the needs and challenges of addressing this issue. Results: Surgical infections comprise a broad range of diseases including intra-abdominal, skin and soft tissue, and healthcare-associated infections and other infectious processes. Treatment of surgical infections requires a functional surgical ecosystem, microbiology services, and appropriate and effective antimicrobial therapy. Systems must be developed and maintained to evaluate screening, prevention, and treatment strategies. Solutions and interventions are proposed focusing on reducing the burden of disease, improving surveillance, strengthening antibiotic stewardship, and enhancing the management of surgical infections. Conclusions: Surgical infections constitute a large burden of disease globally. Challenges to management in LMICs include a shortage of trained personnel and material resources. The increasing rate of antimicrobial drug resistance, likely related to antibiotic misuse, adds to the challenges. Development of surveillance, infection prevention, and antimicrobial stewardship programs are initial steps forward. Education is critical and should begin early in training, be an active process, and be sustained through regular programs.

High Prevalence of Antibiotic-Resistant Gram-Negative Bacteria Causing Surgical Site Infection in a Tertiary Care Hospital of Northeast India

“…Despite improvements in infection control measures, post-surgical infection of wounds remains a significant problem that could be associated with any surgical procedures but commoner in contaminated surgeries as was observed in our current work. Studies show that the incidence of SSI in hepato-biliary, colo-rectal surgeries, cesarean section, and orthopedic surgeries is higher [ 4 - 6 , 10 ]. Gender differences in SSI exist and are procedure-specific [ 11 ].…”

“…About 39-51% of pathogens causing SSI in the USA were documented to be resistant to standard prophylactic antibiotics [ 5 ]. But robust data defining the burden of SSI and the pattern of micro-organisms responsible for causing SSI in LMICs remain scarce compared to high-income countries [ 3 , 4 , 6 ]. Moreover, the suspected estimate of cases can be higher as many minor cases are unreported and undertreated.…”

Antibiotic Use in Low and Middle-Income Countries and the Challenges of Antimicrobial Resistance in Surgery

“…Additionally, regular educational interventions among all healthcare professionals are of the utmost importance, and enlightening interference regarding AMR must begin before a medical student or other health professionals graduate, prior to housemanship, and continuing medical education (CME) throughout the working life. These teaching and learning sessions should adopt active learning methods and need completion as a part of a professional competence to maintain their medical registration or prescriber licenses [ 53 ].…”

Occurrence, associated risk factors, and treatment of surgical site infections in Pakistan

“…Expansion of surveillance, prevention of infection, and antimicrobial stewardship programs are preliminary steps forward and have a role in the prevention of surgical infections. 1 Surgical site infections (SSIs) are common infections developed after surgery. Centers for Disease Control and Prevention (CDC) defined Surgical Site Infections (SSIs) as “infections that occur after surgery at the site of incision, organ, or space.” 2 The ECDC (European Centre for Disease Prevention and Control) postulates the same that SSI must happen within thirty days after surgery without implant.…”