Predictors of Surgical Site Infections among Patients Undergoing Open Urological Surgery at a Tertiary Hospital, Tanzania: A Cross Sectional Study

Abstract

Background: Surgical Site Infection (SSI) is one of the major hospital acquired infections, highly associated with prolonged hospitalisation, morbidity and mortality. In open urological surgeries, little is known on magnitude and factors associated with development of SSI. Methods and Materials: The intervention was a cross-sectional prospective observational study performed between August 2015 and March 2016 at Muhimbili National hospital (MNH), Dar es Salaam, Tanzania. Patients who underwent open urological surgery at MNH during the study period and met inclusion criteria were consecutively enrolled, and followed up for 30 days. Patients´ and operative characteristics were recorded using standard structured questionnaires. Wound/ pus swabs were collected from patients with clinical evidence of SSI for bacteriological processing. Data analysis was performed using SPSS version 20. Results: Of 182 patients who underwent open urological surgery, 22% (40/182) developed SSI. Pre-operative urinary tract infection (aOR 9.73, 95%CI 3.93-24.09, p<.001) and contaminated wound class (aOR 24.997, 95%CI 2.58-242.42, p = .005) were independent predictors for development of SSI. Shaving within 30 hrs before surgical procedure was found to be protective for developing SSI (aOR 0.26, 95%CI 0.09-0.79, p=.02). Escherichia coli (20/40) was the most predominant pathogen in SSI followed by Klebsiella pneumoniae (7/40) and S. aureus (6/40). Gram-negative bacteria were highly resistant to ceftriaxone, gentamicin, amoxicillin-clavulanic acid and trimethoprim-sulfamethoxazole. Conclusion: Surgical Site Infection was high in open urological interventions. Pre-operative urinary tract infection and contaminated wound class predicted SSI. Bacteria causing SSI were highly resistant to commonly used antibiotics.

Prevalence, Risk Factors, and Antimicrobial Resistance of Endemic Healthcare-Associated Infections in Africa: A Systematic Review and Meta-Analysis

“…1). The largest number of studies were from Ethiopia (n = 32, 34.8%) , Egypt (n = 10, 10.9%) [54][55][56][57][58][59][60][61][62][63], Tunisia (n = 7, 7.6%) [64][65][66][67][68][69][70], Tanzania (n = 6, 6.5%) [71][72][73][74][75][76], and Nigeria (n = 5, 5.4%) [77][78][79][80][81]. Other studies were from South Africa (n = 4, 4.3%) [82][83][84][85], Rwanda [86][87][88], Ghana [89][90][91], Cameroon [92][93][94], Sierra Leone [95][96][97], and Morocco [98][99][100] (for each, n = 3, 3.3%), Kenya [101,...…”

Analysis of pathogen distribution and associated risk factors for surgical site infections following laparoscopic urological surgeries

“…SSIs, an unwanted postoperative complication, can significantly increase the length of hospital stay, the overall cost of treatment and can sometimes lead to severe consequences, including sepsis, if not addressed promptly. In urological surgeries, SSIs can be particularly problematic due to the proximity of surgical sites to the urinary tract 8 . Specific scenarios in urological surgeries where the risk of breaching sterile urinary tracts is heightened include transurethral resection of the prostate (TURP), cystoscopy, ureteroscopy and any procedures involving the insertion of a catheter or stent 9–11 .…”

“…In urological surgeries, SSIs can be particularly problematic due to the proximity of surgical sites to the urinary tract. 8 Specific scenarios in urological surgeries where the risk of breaching sterile urinary tracts is heightened include transurethral resection of the prostate (TURP), cystoscopy, ureteroscopy and any procedures involving the insertion of a catheter or stent. 9 , 10 , 11 These interventions inherently carry a higher risk of introducing pathogens directly into the urinary system.…”

Mentoring approaches in a safe surgery program in Tanzania: Lessons learned during COVID-19 and recommendations for the future

“…However, in Africa, surgically related mortality is twice the global average, and postsurgical infection rates are 2 to 10 times higher than the global average [ 3 ]. In Tanzania, where the maternal mortality ratio is among the highest in the world (556 per 100,000 live births) [ 4 ], studies report surgical site infection rates that are 5–18 times higher than rates in high-income countries [ [5] , [6] , [7] , [8] ]. While long-term strategies to strengthen health systems and increase the health workforce are needed to improve access to high-quality surgical care in lower-income settings, clinical mentorship offers a promising intervention to build the capacity of surgical teams in ways that improve health outcomes in the near term [ [9] , [10] , [11] , [12] ].…”