Abstract
Background: Surgical site infection (SSI) is one of the most common healthcare-associated infections, substantially contributing to antibiotic use. Targeted antibiotic prophylaxis and treatment are crucial to controlling antimicrobial resistance (AMR). However, resources and capacity for microbiological testing in low- and middle-income countries (LMIC) are limited. This study aimed to describe the testing capacity and multidrug resistance (MDR) of SSI microorganisms.
Methods: This analysis included patients undergoing abdominal surgery from 35 hospitals in seven LMIC countries as part of the FALCON RCT, between December 2018 and September 2020. Wound swabs were collected from patients diagnosed with SSI, as per Centers for Disease Control and Prevention (CDC) definition. Data on microorganism species and MDR, as per CDC and European Centre for Disease Prevention and Control (ECDC) definitions, were analysed alongside hospital-level data on local microbiological practices. Adjusted analysis was performed to identify perioperative factors associated with MDR.
Results: From 5788 patients, 1163 patients (22.0%) were diagnosed with an SSI. 905/1163 patients (77.8%) received prophylactic antibiotics before surgery and ceftriaxone was the most frequently given (476/1163, 40.9%). In patients with SSI, 935/1163 (80.4%) did not have a wound swab; 195 were from hospitals not performing swabs (15 hospitals) and 740 were from hospitals with capacity but no swab was taken (35 hospitals). Of 228 patients swabbed, 200 (88.5%) had microorganisms detected. Escherichia coli (89/200, 37.9%) was most common, 35/200 (17.5%) were polymicrobial and 116/200 (58.0%) were not covered by the prophylactic antibiotic. MDR was found in 102/147 patients (69.4%). Adjusted analysis found that appropriate prophylactic antibiotic coverage (adjusted odds ratio 0.43, 95% confidence interval 0.20-0.93) and availability of infection control teams (adjusted OR 0.32, 95% CI 0.11-0.94) were associated with a significant reduction in MDR.
Conclusion: Whole system weaknesses exist for the identification and prevention of MDR in hospitals where surgery is performed in LMICs. Expansion of testing capacity, development of local guidelines, and implementation of infection control teams will support the prevention of SSI through directed antibiotic prophylaxis, subsequently reducing the burden of MDR.
Methods: This analysis included patients undergoing abdominal surgery from 35 hospitals in seven LMIC countries as part of the FALCON RCT, between December 2018 and September 2020. Wound swabs were collected from patients diagnosed with SSI, as per Centers for Disease Control and Prevention (CDC) definition. Data on microorganism species and MDR, as per CDC and European Centre for Disease Prevention and Control (ECDC) definitions, were analysed alongside hospital-level data on local microbiological practices. Adjusted analysis was performed to identify perioperative factors associated with MDR.
Results: From 5788 patients, 1163 patients (22.0%) were diagnosed with an SSI. 905/1163 patients (77.8%) received prophylactic antibiotics before surgery and ceftriaxone was the most frequently given (476/1163, 40.9%). In patients with SSI, 935/1163 (80.4%) did not have a wound swab; 195 were from hospitals not performing swabs (15 hospitals) and 740 were from hospitals with capacity but no swab was taken (35 hospitals). Of 228 patients swabbed, 200 (88.5%) had microorganisms detected. Escherichia coli (89/200, 37.9%) was most common, 35/200 (17.5%) were polymicrobial and 116/200 (58.0%) were not covered by the prophylactic antibiotic. MDR was found in 102/147 patients (69.4%). Adjusted analysis found that appropriate prophylactic antibiotic coverage (adjusted odds ratio 0.43, 95% confidence interval 0.20-0.93) and availability of infection control teams (adjusted OR 0.32, 95% CI 0.11-0.94) were associated with a significant reduction in MDR.
Conclusion: Whole system weaknesses exist for the identification and prevention of MDR in hospitals where surgery is performed in LMICs. Expansion of testing capacity, development of local guidelines, and implementation of infection control teams will support the prevention of SSI through directed antibiotic prophylaxis, subsequently reducing the burden of MDR.
| Original language | English |
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| Publisher | SSRN |
| DOIs | |
| Publication status | Published - 10 Nov 2023 |