The burden of surgical site infections and related antibiotic resistance in two geographic regions of Sierra Leone: a prospective study

Abstract

Despite the prolongation of hospitalization, increase in morbidity, mortality and cost of care associated with both surgical site infections (SSIs) and antibiotic resistance, there are limited data on SSIs and antibiotic resistance to guide prevention strategies in Sierra Leone. This study assessed the burden of SSIs and related antibiotic resistance in the 34 Military Hospital (MH) and Makeni Government Hospital (MGH) located in two geographic regions of Sierra Leone using a prospective study design to collect data from adults aged 18 years or older. Of the 417 patients, 233 (55.9%) were enrolled in MGH. Most were women 294 (70.5%). The incidence rate of SSI was 5.5 per 1000 patient-days, and the cumulative incidence of SSI was 8.2%. Common bacteria isolated in MH were Escherichia coli (6,33.3%) and Pseudomonas aeruginosa (3,16.7%) and in MGH were P. aeruginosa (3,42.9%) and Proteus mirabilis (2,28.9%). Of the gram-negative bacteria, 40% were Extended-spectrum beta-lactamase-producing Enterobacteriaceae, 33% were Carbapenem-resistant P. aeruginosa and 10% were carbapenem-resistant Enterobacteriaceae. Although the incidence of SSIs in our study is lower than previously reported, the rate of antibiotic resistance reported in this study is high. Urgent action is needed to invest in the microbiology infrastructure to support SSI surveillance and prevention strategies.

A case for routine microbial diagnostics: Results from antimicrobial susceptibility testing in post-traumatic wound infections at a Ugandan tertiary care hospital

“…coli and Acinetobacter spp.. These results corresponds to data of trauma wards in other low resource settings, which show similar pathogen distributions in wound infections [ 26 – 28 , 39 ]. Of the five most common pathogens in our sample, three were intrinsically resistant to the most commonly used empiric treatment ceftriaxone ( Acinetobacter spp., P .…”

High incidence of catheter-associated urinary tract infections and related antibiotic resistance in two hospitals of different geographic regions of Sierra Leone: a prospective cohort study

“…Among the isolates in the critical pathogen group, we identified a high burden of ESBL Enterobacteriaceae from the urine of patients with CAUTI. The high burden of ESBL Enterobacteriaceae is a persistent problem, as previous studies in Sierra Leone have reported a similar ESBL burden in patients with surgical site infections [ 35 , 36 ]. As alluded to earlier, the inappropriate antibiotic use and the challenges of hand hygiene compliance and implementation reported in some facilities in Sierra Leone may underlie the spread of ESBL Enterobacteriaceae in our healthcare settings [ 15 , 16 , 32 – 34 ].…”

Antibiotic use and consumption in Freetown, Sierra Leone: A baseline report of prescription stewardship in outpatient clinics of three tertiary hospitals

“…Currently, Sierra Leone has limited data on bacterial sensitivity to guide national AMS interventions. However, data from small studies have shown a high burden of antibiotic resistance, and identified gaps in hand hygiene and antibiotic prescribing practices [12] , [13] , [14] , [15] , [16] , [17] .…”