Incidence of Surgical Site Infection and Use of Antibiotics among Patients Who Underwent Caesarean Section and Herniorrhaphy at a Regional Referral Hospital, Sierra Leone

Abstract

Surgical site infections (SSIs) are common postoperative complications. Surgical antibiotic prophylaxis (SAP) can prevent the occurrence of SSIs if administered appropriately. We carried out a retrospective cohort study to determine the incidence of SSIs and assess whether SAP were administered according to WHO guidelines for Caesarean section (CS) and herniorrhaphy patients in Bo regional government hospital from November 2019 to October 2020. The analysis included 681 patients (599 CSs and 82 herniorrhaphies). Overall, the SSI rate was 6.7% among all patients, and 7.5% and 1.2% among CS patients and herniorrhaphy patients, respectively. SAP was administered preoperatively in 85% of CS and 70% of herniorrhaphy patients. Postoperative antibiotics were prescribed to 85% of CS and 100% of herniorrhaphy patients. Ampicillin, metronidazole, and amoxicillin were the most commonly used antibiotics. The relatively low rate of SSIs observed in this study is probably due to improved infection prevention and control (IPC) measures following the Ebola outbreak and the current COVID-19 pandemic. A good compliance rate with WHO guidelines for preoperative SAP was observed. However, there was a high use of postoperative antibiotics, which is not in line with WHO guidelines. Recommendations were made to ensure the appropriate administration of SAP and reduce unnecessary use of antibiotics.

Antibiotic Prescribing Patterns and Prevalence of Surgical Site Infections in Caesarean Section Deliveries at Two Tertiary Hospitals in Lusaka, Zambia

“…Conversely, the prevalence of SSIs found in our study was lower than what was found in similar studies with a prevalence of 10.9% in Tanzania [36], 11% in Ethiopia [37], 16.2% in Nigeria [38], 12.6% in Nepal [39] and 24.3% in Pakistan [40]. These results are not consistent with another study [41] which found that 7.5% of the CS deliveries had SSIs. This is presumably due to the long duration of prophylaxis [41].…”

“…These results are not consistent with another study [41] which found that 7.5% of the CS deliveries had SSIs. This is presumably due to the long duration of prophylaxis [41]. Some other studies have indicated that emergency CS deliveries have been linked to SSIs, due to highly urgent operations with fewer concerns about sterility and the absence of prophylactic antibiotics administered on time [31] [42] [43] [44].…”

Antibiotic use among hospitalised patients in Sierra Leone: a national point prevalence survey using the WHO survey methodology

“…In keeping with our findings, a recently published study on antibiotic use among suspected and confirmed COVID-19 cases admitted to 35 COVID-19 hospitals in Sierra Leone also documented a high prevalence of antibiotic use, as over half of the patients admitted to these centres received an antibiotic 15. Several other studies conducted in the general patient population including surgical patients have also demonstrated a high prevalence of antibiotic use 22 30–32. Additionally, a multicentre PPS on antibiotic use in Ethiopian hospitals that involved a review of over 1800 patient records documented a high prevalence (63.8%) of antibiotic use 33.…”

Hospital Perinatal Transmission Dynamics of Antimicrobial Resistance, Bangladesh, 2020

“…[36] Similar practices have been reported from other LMICs, indicating the use of prolonged prophylactic antibiotics for Csection may be widespread, despite evidence showing no benefit from multiple doses of antibiotics. [37][38][39][40] This contrasts with practices in high-resource contexts, such as the U.S., where multiple doses of antibiotics is rare. [41,42] Although the analysis conducted here was exploratory, prior hospitalization was consistently associated with increased risk for maternal ESBL/CRO colonization, implicating the role of healthcare settings in the propagation of AMR.…”