Surgical Site Infection: The Rate and Antimicrobial Sensitivity Pattern in Electively Operated Surgical and Gynecological Patients at Kilimanjaro Christian Medical Centre, Northern Tanzania

Abstract

Background: Surgical site infections are dreaded by many as they impose a greater economic costs, morbidity and mortality that in developing countries place a burden on an already burdened healthcare system. In Tanzania previously studies done in different centers reported high rates of Surgical Site Infection. This study aimed to quantify in a low income, tertiary hospital, the rate of Surgical Site infections, microorganisms implicated and their respective sensitivity pattern to local antibiotics, and associated perioperative risk factors in electively operated surgical and gynecological patients at Kilimanjaro Christian Medical Centre.Method: 301 patients admitted for elective procedures in the surgical and gynecological units were enrolled consecutively after consenting for the study. A standardized data collection form was used to record patients' information on perioperative risk factors. Patients were followed up in surgical outpatient clinic up to one month post discharge. Swabs from wounds showing signs of infection were taken for culture and sensitivity and processed at the laboratory as per standard operating procedures.Results: Out of a total of 301 patients, 181 patients were from general surgical ward and 115 from gynecological wards. Females were more than males (3:1) with most, 43.9% within the age group 40 to 60 years. Overall, 21.3% of the patients developed surgical site infection. 71 organisms were isolated, S. Aureus species were the leading cause of surgical site infections making 52% of the total isolates. Most of the gram positive organisms were resistant to ampicillin, the common antibiotic used in the gynecology unit. Contaminated wounds were 10 times more likely to develop surgical site infections, and clean contaminated wounds fi ve times when compared to clean wounds. Duration of procedure, Surgeons skills, wound class and number of people in theater showed signifi cant association with surgical site infection, however only wound class and duration of procedure remained statistically signifi cant after a multivariate analysis. Conclusion:We found an SSI rate of 21.3%, slightly higher than previous studies in the same center. The wound class and duration of procedure remained signifi cant risk factors after logistic regression analysis. As with other studies, S. Aureus was the most common causative organism for SSI isolated from our study.

Surgical Antibiotic Prophylaxis Practices and Occurrence of Surgical Site Infections Among Operated Patients at Dodoma Regional Referral Hospital, Tanzania

“…Almost all patients in the current study received single antibiotic preoperatively (99%). Similarly other studies have shown that single preoperative of antibiotic prophylaxis could decrease, occasionally dramatically the risk of SSIs [50]. A Study done in our country also showed significant reduction in SSIs when single preoperative prophylactic antibiotic was used.…”

“…Also a study done at KCMC found out that about 30% of patients who got prophylactic antibiotics (ampicillin) developed SSIs as compared to 15.6% who didn't get prophylactic antibiotics. The author attributed these unexpected results to confounders, after accounting for other factors [50].…”

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] ].…”

Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention

“…7 Studies in Tanzania have reported high surgical site infection (SSI) rates ranging from 21.3% to 48.0% among patients undergoing surgery, including CS. [8][9][10][11][12][13] These rates are 5-18 times higher than rates in high-income countries.…”