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Multidrug-resistant surgical site infections in a humanitarian surgery project

  • R. A. MURPHY (a1), O. OKOLI (a2), I. ESSIEN (a2), C. TEICHER (a3), G. ELDER (a4), J. PENA (a4), J.-B. RONAT (a4) and K. J. BERNABÉ (a5)...

Summary

The epidemiology of surgical site infections (SSIs) in surgical programmes in sub-Saharan Africa is inadequately described. We reviewed deep and organ-space SSIs occurring within a trauma project that had a high-quality microbiology partnership and active follow-up. Included patients underwent orthopaedic surgery in Teme Hospital (Port Harcourt, Nigeria) for trauma and subsequently developed a SSI requiring debridement and microbiological sampling. Data were collected from structured chart reviews and programmatic databases for 103 patients with suspected SSI [79% male, median age 30 years, interquartile range (IQR) 24–37]. SSIs were commonly detected post-discharge with 58% presenting >28 days after surgery. The most common pathogens were: Staphylococcus aureus (34%), Pseudomonas aeruginosa (16%) and Enterobacter cloacae (11%). Thirty-three (32%) of infections were caused by a multidrug-resistant (MDR) pathogen, including 15 patients with methicillin-resistant S. aureus. Antibiotics were initiated empirically for 43% of patients and after culture and sensitivity report in 32%. The median number of additional surgeries performed in patients with SSI was 5 (IQR 2–6), one patient died (1%), and amputation was performed or recommended in three patients. Our findings suggest the need for active long-term monitoring of SSIs, particularly those associated with MDR organisms, resulting in increased costs for readmission surgery and treatment with late-generation antibiotics.

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Copyright

Corresponding author

*Author for correspondence: R. A. Murphy, MD, MPH, Division of Infectious Diseases, Harbor–UCLA Medical Center, 1000 W. Carson Street, Box 466, Torrance, CA, USA. (Email: ramurphy@gmail.com)

References

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Keywords

Multidrug-resistant surgical site infections in a humanitarian surgery project

  • R. A. MURPHY (a1), O. OKOLI (a2), I. ESSIEN (a2), C. TEICHER (a3), G. ELDER (a4), J. PENA (a4), J.-B. RONAT (a4) and K. J. BERNABÉ (a5)...

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