title: 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.
authors: Division of Infectious Diseases,Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center,Torrance,CA,USA.
authors: R A
authors: RA
authors: Murphy
authors: Doctors Without Borders,Abuja,Nigeria.
authors: O
authors: O
authors: Okoli
authors: Doctors Without Borders,Abuja,Nigeria.
authors: I
authors: I
authors: Essien
authors: Epicentre,Paris,France.
authors: C
authors: C
authors: Teicher
authors: Médecins Sans Frontières,Paris,France.
authors: G
authors: G
authors: Elder
authors: Médecins Sans Frontières,Paris,France.
authors: J
authors: J
authors: Pena
authors: Médecins Sans Frontières,Paris,France.
authors: J-B
authors: JB
authors: Ronat
authors: Doctors Without Borders,New York,NY,USA.
authors: K J
authors: KJ
authors: Bernabé
keywords: Multidrug resistance; nosocomial infection; resource-limited setting; surgical site infection