Abstract
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.
Highlights
There is limited data to guide the prevention and management of surgical site infections (SSI) in lowand middle-income countries
We prospectively identified the aetiological agents of SSI at the surgical department of a tertiary hospital in Ghana, with emphasis on their antibiotic susceptibility patterns, and related to the patient characteristics
From 382 (87%) of the 438 patients, a wound swab was taken for microbiological analysis
Summary
There is limited data to guide the prevention and management of surgical site infections (SSI) in lowand middle-income countries. Surgical site infections (SSI) is a major type of healthcare associated infections (HCAI), forming as much as 33% of all HCAI in sub-Saharan Africa [1, 2]. The prevalence of antibiotic use among surgical patients in sub-Saharan Africa is 24–73% [6], and the majority of these antibiotics are prescribed for prophylaxis and usually beyond the recommended 24-h period [7]. Reasons for this prolonged antibiotic use include a fear of infections due to poor infection control [8]
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