Surgical Site Infection Complicating Digestive Surgery in Developing Countries

Abstract

Surgical site infections are frequent and responsible for significant morbidity in patients who undergo digestive surgery. However, very little is known about the aspects of surgical site infections in sub-Saharan Africa. The purpose of this study was to assess the prevalence and identify risk factors of surgical site infections in patients who were treated in the Digestive Surgery Department of Tenkodogo Regional Hospital in Burkina Faso. From 1 January to 31 December 2016 we performed a descriptive study in the Department of Digestive Surgery of Tenkodogo Regional Hospital in Burkina Faso. All patients who underwent digestive tract surgery during this period were followed. Those patients whose post-operative surgical sites were complicated by infection were included in this study. Surgical site infection was diagnosed according to the CDC definition. Bacteriological sampling was performed in all included patients. In all, 964 patients underwent surgery during the study period. One-hundred--fourteen patients presented with surgical site infection, the rate of which was 11.8%. The mean age of the included patients was 48.7 years. Seventy-two patients were women (63.2%) and 42 were men. The risk of surgical site infection was significantly higher in women than in men (74.2% vs 25.8%, p <0.001). The risk was also higher in patients living below the poverty line (71% vs 29%, p <0.001). Clinically, the risk of surgical site infection was higher in emergency surgery than in scheduled surgery (16.7% vs 4.6%, p<0.001). Contaminated surgery, or dirty surgery, was significantly more risky than clean surgery (p<0.001). With respect to bacteria, the most commonly isolated microbes were E. coli (66.7%) and S. aureus (15%). Treatment mainly consisted of appropriate antibiotic therapy and local care. Three deaths were recorded for a mortality rate of 2.6%. Surgical site infections are frequent in sub-Saharan environments. The risk factors for surgical site infection are related to poverty.