Surveillance of surgical site infection in a teaching hospital in Ghana: a prospective cohort study

Bediako-Bowan, Antoinette; Owusu, Enid; Debrah, Samuel; Kjerulf, Anne; Newman, Mercy J.; Kurtzhals, Jørgen A. L.; Mølbak, Kåre

doi:10.1016/j.jhin.2020.01.004

Cited by 20 publications

(38 citation statements)

References 13 publications

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“…Patients undergoing implant surgery or whose wounds were not primarily closed in the OR were excluded. The study formed part of ongoing surveillance of SSI but with the collection of additional exposure variables [7]. Ethical approval was granted by the Korle Bu Teaching Hospital Institutional Review Board, KBTH-STC/IRB/00005/2019 and the College of Health Sciences' Ethical and Protocol review committee, CHS-Et/M.5 -4.10/ 2018-2019.…”

Section: Methodsmentioning

confidence: 99%

Risk factors for surgical site infections in abdominal surgeries in Ghana: emphasis on the impact of operating rooms door openings

et al. 2020

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Major surgery carried out in low- and middle-income countries is associated with a high risk of surgical site infections (SSI), but knowledge is limited regarding contributory factors to such infections. This study explores factors related to patients developing an SSI in a teaching hospital in Ghana. A prospective cohort study of patients undergoing abdominal surgical procedures was conducted at Korle Bu Teaching Hospital. Patient characteristics, procedures and environmental characteristics were recorded. A 30-day daily surveillance was used to diagnose SSI, and Poisson regression analysis was used to test for association of SSI and risk factors; survival was determined by proportional hazard regression methods. We included 358 patients of which 58 (16.2%; 95% CI 12.7–20.4%) developed an SSI. The median number of door openings during an operation was 79, with 81% being unnecessary. Door openings greater than 100 during an operation (P = 0.028) significantly increased a patient's risk of developing an SSI. Such patients tended to have an elevated mortality risk (hazard ratio 2.67; 95% CI 0.75–9.45, P = 0.128). We conclude that changing behaviour and practices in operating rooms is a key strategy to reduce SSI risk.

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Section: Methodsmentioning

confidence: 99%

Risk factors for surgical site infections in abdominal surgeries in Ghana: emphasis on the impact of operating rooms door openings

et al. 2020

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“…Study site, patient recruitment and collection of samples Samples were collected as part of a cohort study at the surgical department of the Korle Bu Teaching Hospital from July 2017 to April 2019. The study design and results (for the period July 2017-December 2018) of the surveillance have been reported elsewhere 3 . All patients who underwent surgery in the unit were followed actively for the occurrence of SSI during admission and post-discharge for 30 days, and infection was de ned according to Centers of Disease Control and Prevention (CDC) criteria 3,10 .…”

Section: Methodsmentioning

confidence: 99%

“…The study design and results (for the period July 2017-December 2018) of the surveillance have been reported elsewhere 3 . All patients who underwent surgery in the unit were followed actively for the occurrence of SSI during admission and post-discharge for 30 days, and infection was de ned according to Centers of Disease Control and Prevention (CDC) criteria 3,10 . Wound contamination and SSI type were classi ed based on the CDC classi cation 10 .…”

Section: Methodsmentioning

confidence: 99%

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High Rates of Multi-Drug Resistant Gram-Negative Organisms Associated With Surgical Site Infections in a Teaching Hospital in Ghana

Bediako-Bowan

Kurtzhals

Mølbak

et al. 2020

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Background There is limited data to guide the prevention and management of surgical site infections (SSI) in low- and middle-income countries. We prospectively studied aetiological agents associated with SSI and their corresponding antibiotic susceptibility patterns in a tertiary hospital in Ghana. Methods As part of a cohort study carried out at the surgical department of the Korle Bu Teaching Hospital (KBTH) from July 2017 to April 2019, wound swabs were collected from patients diagnosed with SSI. Isolates cultured from the wound swabs were identified by MALDI TOF and susceptibility testing was conducted according to EUCAST 2020 guidelines. Clinical data were monitored prospectively. Results Of 4577 patients, 438 developed an SSI and 352 microbial isolates were cultured. Isolates were predominantly Gram negative (286, 81%), a pattern seen for all kinds of surgery and all wound classes. The most common species included Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus and Acinetobacter baumannii. The majority of organisms were multi-drug resistant including 86% of E. coli, 52% of A. baumannii and 86% of K. pneumoniae; and 65% (17/26) of the cefotaxime-resistant K. pneumoniae were extended spectrum β-lactamase producing. One of 139 E. coli, 15 of 49 P. aeruginosa, and 6 of 23 A. baumannii were meropenem resistant, but no clonal pattern was found. There was a 1% (5/428) prevalence of methicillin-resistant S. aureus. Conclusions The predominance of Gram-negative organisms and the high level of multi-drug resistance indicate a need to re-evaluate antibiotic prophylaxis and treatment protocols in surgical practice in low- and middle-income countries.

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“…Study site, patient recruitment and collection of samples Samples were collected as part of a cohort study at the surgical department of the Korle Bu Teaching Hospital from July 2017 to April 2019. The study design and results (for the period July 2017-December 2018) of the surveillance have been reported elsewhere (3). All patients who underwent surgery in the unit were followed actively for the occurrence of SSI during admission and postdischarge for 30 days, and infection was de ned according to Centers of Disease Control and Prevention (CDC) criteria (3,10).…”

Section: Methodsmentioning

confidence: 99%

High rates of multi-drug resistant Gram-negative organisms associated with surgical site infections in a teaching hospital in Ghana

Bediako-Bowan

Kurtzhals

Mølbak

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundThere is limited data to guide the prevention and management of surgical site infections (SSI) in low- and middle-income countries. We prospectively studied aetiological agents associated with SSI and their corresponding antibiotic susceptibility patterns in a tertiary hospital in Ghana.MethodsAs part of a cohort study carried out at the surgical department of the Korle Bu Teaching Hospital (KBTH) from July 2017 to April 2019, wound swabs were collected from patients diagnosed with SSI. Isolates cultured from the wound swabs were identified by MALDI TOF and susceptibility testing was conducted according to EUCAST 2020 guidelines. Clinical data were monitored prospectively.ResultsOf 4577 patients, 438 developed an SSI and 352 microbial isolates were cultured. Isolates were predominantly Gram negative (286, 81%), a pattern seen for all kinds of surgery and all wound classes. The most common species included Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus and Acinetobacter baumannii. The majority of organisms were multi-drug resistant including 86% of E. coli, 52% of A. baumannii and 86% of K. pneumoniae; and 65% (17/26) of the cefotaxime-resistant K. pneumoniae were extended spectrum β-lactamase producing. One of 139 E. coli, 15 of 49 P. aeruginosa, and 6 of 23 A. baumannii were meropenem resistant, but no clonal pattern was found. There was a 1% (5/428) prevalence of methicillin-resistant S. aureus.ConclusionsThe predominance of Gram-negative organisms and the high level of multi-drug resistance indicate a need to re-evaluate antibiotic prophylaxis and treatment protocols in surgical practice in low- and middle-income countries.

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Surveillance of surgical site infection in a teaching hospital in Ghana: a prospective cohort study

Cited by 20 publications

References 13 publications

Risk factors for surgical site infections in abdominal surgeries in Ghana: emphasis on the impact of operating rooms door openings

Risk factors for surgical site infections in abdominal surgeries in Ghana: emphasis on the impact of operating rooms door openings

High Rates of Multi-Drug Resistant Gram-Negative Organisms Associated With Surgical Site Infections in a Teaching Hospital in Ghana

High rates of multi-drug resistant Gram-negative organisms associated with surgical site infections in a teaching hospital in Ghana

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