Surveillance of post-caesarean surgical site infections in a hospital with limited resources, Cambodia.
BACKGROUND
In Cambodia, we implemented a pilot surveillance of superficial surgical site infections (SSSI) following caesarean deliveries (CD) in a provincial hospital, to estimate their incidence, describe their clinical management, and determine their causative pathogens.


METHODS
Between October 2010 and February 2011, all women admitted for CD were included in the surveillance. Their clinical condition was monitored for a post-operative period of 30 days, including two assessments performed by surgeons. Cases were clinically diagnosed by surgeons, with bacterial cultures performed.


RESULTS
Of the 222 patients admitted for CD, 176 (79.3%) were monitored for 30 days. Of these, 11 were diagnosed with a SSSI, giving an incidence rate of 6.25% (95% CI 3.2-10.9). Four of the cases (36.4%) were detected after hospital discharge. Length of hospitalization was significantly longer for the SSSI cases. All 222 patients were prescribed antibiotics. Ampicillin was administered intravenously to 98.6% of them, with subsequent oral amoxicillin given to 82.9%. Three of six pus samples collected were positive on culture: two with Staphylococcus aureus and one with Staphylococcus lugdunensis. One S.aureus was methicillin resistant (MRSA). The other was clindamycin and erythromycin resistant.


CONCLUSIONS
Surveillance of health-care associated infections in a setting with limited resources is challenging but feasible. Effective post-discharge surveillance was essential for the estimation of the incidence rate of SSSI following caesarean deliveries. This surveillance led to a peer-review of medical practices.
Department of Hospital Services, Ministry of Health, Phnom Penh, Cambodia. soksrun@camnet.com.kh
Sok
S
Srun
Yin
Y
Sinath
An Thoun
AT
Seng
Meas
M
Chea
Mony
M
Borin
Somary
S
Nhem
Amanda
A
Daniel
Nora
N
Chea
Nima
N
Asgari
Anne
A
Rachline
Za
Z
Reed
Rodney
R
Hoff
Philippe
P
Cavailler
Sophie
S
Goyet
D000293:Adolescent; D000328:Adult; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D002160:Cambodia / Q000453:epidemiology; D002585:Cesarean Section / Q000009:adverse effects*; D003906:Developing Countries; D062665:Epidemiological Monitoring; D005260:Female; D006761:Hospitals; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011247:Pregnancy; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult