Abstract
Surgical site infection (SSI) following caesarean section is associated with increased morbidity, mortality, and significant health care costs. This study evaluated the epidemiological, clinical, and microbiological features of Acinetobacter spp. in women with SSIs who have undergone caesarean section at a referral hospital in the Brazilian Amazon region. This study included 69 women with post-caesarean SSI by Acinetobacter spp. admitted to the hospital between January 2012 and May 2015. The 69 Acinetobacter isolates were subjected to molecular species identification, antimicrobial susceptibility testing, detection of carbapenemase-encoding genes, and genotyping. The main complications of post-caesarean SSI by Acinetobacter were inadequate and prolonged antibiotic therapy, sepsis, prolonged hospitalization, and re-suture procedures. A. baumannii, A. nosocomialis and A. colistiniresistens species were identified among the isolates. Carbapenem resistance was associated with OXA-23-producing A. baumannii isolates and IMP-1-producing A. nosocomialis isolate. Patients with multidrug-resistant A. baumannii infection showed worse clinical courses. Dissemination of persistent epidemic clones was observed, and the main clonal complexes (CC) for A. baumannii were CC231 and CC236 (Oxford scheme) and CC1 and CC15 (Pasteur scheme). This is the first report of a long-term Acinetobacter spp. outbreak in women who underwent caesarean section at a Brazilian hospital. This study demonstrates the impact of multidrug resistance on the clinical course of post-caesarean infections.
Highlights
Surgical site infection (SSI) following caesarean section is associated with increased morbidity, mortality, and significant health care costs
From January 2012 to May 2015, a total of 69 women submitted to caesarean section at the study hospital acquired a surgical site infection by Acinetobacter spp
This study demonstrated an association between septicemia and other complications, such as the need for further surgery, extended hospital stay (6 to 80 days), and OXA-23producing A. baumannii infection, with the epidemic clonal complexes CC236 (ST692, ST225 and ST236) and CC231 (ST231 and ST405) (Oxford scheme), and ST902 (CC1) and ST15 (CC15) (Pasteur scheme), demonstrating the severity of these specific infections
Summary
Surgical site infection (SSI) following caesarean section is associated with increased morbidity, mortality, and significant health care costs. This study included 69 women with post-caesarean SSI by Acinetobacter spp. admitted to the hospital between January 2012 and May. 2015. The main complications of post-caesarean SSI by Acinetobacter were inadequate and prolonged antibiotic therapy, sepsis, prolonged hospitalization, and re-suture procedures. Dissemination of persistent epidemic clones was observed, and the main clonal complexes (CC) for A. baumannii were CC231 and CC236 (Oxford scheme) and CC1 and CC15 (Pasteur scheme) This is the first report of a long-term Acinetobacter spp. outbreak in women who underwent caesarean section at a Brazilian hospital. SSI following caesarean section is associated with increased morbidity and mortality, prolonged hospitalization, secondary infertility, and increased health care costs [3]. Microorganisms 2021, 9, 743 generated by post-caesarean SSI include prolonged healing time after surgery due to several factors, e.g., wound dehiscence, prolonged hospital admission, prolonged use of antibiotics, possibility of re-admission and re-suture, sepsis and, in rare cases, mortality [1]
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