Surgery for Conditions of Infectious Etiology in Resource-Limited Countries Affected by Crisis: The Médecins Sans Frontières Operations Centre Brussels Experience

Abstract

Background: Surgery for infection represents a substantial, although undefined, disease burden in low-and middleincome countries (LMICs). Médecins Sans Frontières-Operations Centre Brussels (MSF-OCB) provides surgical care in LMICs and collects data useful for describing operative epidemiology of surgical need otherwise unmet by national health services. This study aimed to describe the experience of MSF-OCB operations for infections in LMICs. By doing so, the results might aid effective resource allocation and preparation of future humanitarian staff. Methods: Procedures performed in operating rooms at facilities run by MSF-OCB from July 2008 through June 2014 were reviewed. Projects providing specialty care only were excluded. Procedures for infection were described and related to demographics and reason for humanitarian response. Results: A total of 96,239 operations were performed at 27 MSF-OCB sites in 15 countries between 2008 and 2014. Of the 61,177 general operations, 7,762 (13%) were for infections. Operations for skin and soft tissue infections were the most common (64%), followed by intra-abdominal (26%), orthopedic (6%), and tropical infections (3%). The proportion of operations for skin and soft tissue infections was highest during natural disaster missions ( p < 0.001), intra-abdominal infections during hospital support missions (p < 0.001) and orthopedic infections during conflict missions (p < 0.001). Conclusion: Surgical infections are common causes for operation in LMICs, particularly during crisis. This study found that infections require greater than expected surgical input given frequent need for serial operations to overcome contextual challenges and those associated with limited resources in other areas (e.g., ward care). Furthermore, these results demonstrate that the pattern of operations for infections is related to nature of the crisis. Incorporating training into humanitarian preparation (e.g., surgical sepsis care, ultrasound-guided drainage procedures) and ensuring adequate resources for the care of surgical infections are necessary components for providing essential surgical care during crisis.

Update of incidence and antimicrobial susceptibility trends of Escherichia coli and Klebsiella pneumoniae isolates from Chinese intra-abdominal infection patients

“…Intra-abdominal infections (IAIs) are the second most common cause of sepsis in intensive care units (ICU) [ 1 ] where they are the second most common cause of infection-related mortality [ 2 ]. IAIs are also the second most common cause of infection related to surgical interventions and according to a multicenter observational study in 68 medical institutions worldwide, [ 3 ] the overall mortality rate of patients with complicated IAIs in 2012–2013 was 10.5%, [ 4 ], with ESBL producing bacteria being a particular challenge for treatment [ 5 ]. However, initiation of appropriate antimicrobial therapy can significantly reduce the mortality rate of IAI-induced septic shock [ 6 ].…”

The Early Recognition and Management of Sepsis in Sub-Saharan African Adults: A Systematic Review and Meta-Analysis

“…Adequate source control is an essential component of sepsis management; IMAI guidelines suggest drainage of any surgical infection within 2–6 h of sepsis diagnosis [ 6 ]. However, obstetric and surgical management for septic conditions is frequently delayed in sub-Saharan Africa [ 55 ]. As a result, damage control surgery must frequently be employed with multiple subsequent returns to theatre, burdensome in a low-resource health care setting [ 55 ].…”

“…However, obstetric and surgical management for septic conditions is frequently delayed in sub-Saharan Africa [ 55 ]. As a result, damage control surgery must frequently be employed with multiple subsequent returns to theatre, burdensome in a low-resource health care setting [ 55 ]. Where surgical delay is unavoidable, percutaneous drainage of uncontrolled abdominal infection or hydronephrosis have been advocated [ 55 ].…”

“…As a result, damage control surgery must frequently be employed with multiple subsequent returns to theatre, burdensome in a low-resource health care setting [ 55 ]. Where surgical delay is unavoidable, percutaneous drainage of uncontrolled abdominal infection or hydronephrosis have been advocated [ 55 ]. Potentially, point-of-care ultrasound could also be used to rapidly identify and treat other drainable collections (e.g., empyema) [ 56 ].…”

Surgical interventions for pulmonary tuberculosis in Mumbai, India: surgical outcomes and programmatic challenges

“…12 Unfortunately, this is not the reality in many LMICs with fragile health systems. 13 The high burden of MDR-TB in Mumbai, and in the whole of India, and the existence of expertise and facilities, create a clear need and opportunity for early identification of potential candidates for elective resection surgery and enrolment in randomised controlled trials. Patients are usually referred for surgical evaluation on an emergency basis, however, when treatment has been failing for a long time and a large part of the lung parenchyma has already been destroyed.…”