Surgical Site Infections and Antimicrobial Resistance After Cesarean Section Delivery in Rural Rwanda
Background: As the volume of surgical cases in low- and middle-income countries (LMICs) increases, surgical-site infections (SSIs) are becoming more prevalent with anecdotal evidence of antimicrobial resistance (AMR), despite a paucity of data on resistance patterns. Objectives: As a primary objecti...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Ubiquity Press
2021-08-01
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| Series: | Annals of Global Health |
| Online Access: | https://annalsofglobalhealth.org/articles/3413 |
| _version_ | 1818460272671588352 |
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| author | Lotta Velin Grace Umutesi Robert Riviello Moses Muwanguzi Lisa M. Bebell Marthe Yankurije Kara Faktor Theoneste Nkurunziza Gilbert Rukundo Jean de Dieu Gatete Ivan Emil Bethany L. Hedt-Gauthier Fredrick Kateera |
| author_facet | Lotta Velin Grace Umutesi Robert Riviello Moses Muwanguzi Lisa M. Bebell Marthe Yankurije Kara Faktor Theoneste Nkurunziza Gilbert Rukundo Jean de Dieu Gatete Ivan Emil Bethany L. Hedt-Gauthier Fredrick Kateera |
| author_sort | Lotta Velin |
| collection | DOAJ |
| description | Background: As the volume of surgical cases in low- and middle-income countries (LMICs) increases, surgical-site infections (SSIs) are becoming more prevalent with anecdotal evidence of antimicrobial resistance (AMR), despite a paucity of data on resistance patterns. Objectives: As a primary objective, this prospective study aimed to describe the epidemiology of SSIs and the associated AMR among women who delivered by cesarean at a rural Rwandan hospital. As secondary objectives, this study also assessed patient demographics, pre- and post-operative antibiotic use, and SSI treatment. Methods: Women who underwent cesarean deliveries at Kirehe District Hospital between September 23rd, 2019, and March 16th, 2020, were enrolled prospectively. On postoperative day (POD) 11 (+/− 3 days), their wounds were examined. When an SSI was diagnosed, a wound swab was collected and sent to the Rwandan National Reference Laboratory for culturing and antibiotic susceptibility testing. Findings: Nine hundred thirty women were enrolled, of whom 795 (85.5%) returned for the POD 11 clinic visit. 45 (5.7%) of the 795 were diagnosed with SSI and swabs were collected from 44 of these 45 women. From these 44 swabs, 57 potential pathogens were isolated. The most prevalent bacteria were coagulase-negative staphylococci (n = 12/57, 20.3% of all isolates), and Acinetobacter baumannii complex (n = 9/57, 15.2%). 68.4% (n = 39) of isolates were gram negative; 86.7% if excluding coagulase-negative staphylococci. No gram-negative pathogens isolated were susceptible to ampicillin, and the vast majority demonstrated intermediate susceptibility or resistance to ceftriaxone (92.1%) and cefepime (84.6%). Conclusions: Bacterial isolates from SSI swab cultures in rural Rwanda predominantly consisted of gram-negative pathogens and were largely resistant to commonly used antibiotics. This raises concerns about the effectiveness of antibiotics currently used for surgical prophylaxis and treatment and may guide the appropriate selection of treatment of SSIs in rural Rwanda and comparable settings. |
| first_indexed | 2024-12-14T23:27:37Z |
| format | Article |
| id | doaj.art-114b2c84fe8b48b3851992b38d48c11d |
| institution | Directory Open Access Journal |
| issn | 2214-9996 |
| language | English |
| last_indexed | 2024-12-14T23:27:37Z |
| publishDate | 2021-08-01 |
| publisher | Ubiquity Press |
| record_format | Article |
| series | Annals of Global Health |
| spelling | doaj.art-114b2c84fe8b48b3851992b38d48c11d2022-12-21T22:43:46ZengUbiquity PressAnnals of Global Health2214-99962021-08-0187110.5334/aogh.34132659Surgical Site Infections and Antimicrobial Resistance After Cesarean Section Delivery in Rural RwandaLotta Velin0Grace Umutesi1Robert Riviello2Moses Muwanguzi3Lisa M. Bebell4Marthe Yankurije5Kara Faktor6Theoneste Nkurunziza7Gilbert Rukundo8Jean de Dieu Gatete9Ivan Emil10Bethany L. Hedt-Gauthier11Fredrick Kateera12Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, US; Partners In Health, Kigali, RW; Surgery and Public Health, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, LundPartners In Health, KigaliProgram in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MAPartners In Health, KigaliMassachusetts General Hospital Division of Infectious Diseases, Medical Practice Evaluation Center, and MGH Center for Global Health, Boston, MAPartners In Health, KigaliDepartment of Global Health and Social Medicine, Harvard Medical School, Boston, MAPartners In Health, Kigali, RW; Epidemiology, Department for Sport and Health Sciences, Technical University of Munich, MunichPartners In Health, KigaliPartners In Health, KigaliNational Reference Laboratory, KigaliProgram in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MAPartners In Health, KigaliBackground: As the volume of surgical cases in low- and middle-income countries (LMICs) increases, surgical-site infections (SSIs) are becoming more prevalent with anecdotal evidence of antimicrobial resistance (AMR), despite a paucity of data on resistance patterns. Objectives: As a primary objective, this prospective study aimed to describe the epidemiology of SSIs and the associated AMR among women who delivered by cesarean at a rural Rwandan hospital. As secondary objectives, this study also assessed patient demographics, pre- and post-operative antibiotic use, and SSI treatment. Methods: Women who underwent cesarean deliveries at Kirehe District Hospital between September 23rd, 2019, and March 16th, 2020, were enrolled prospectively. On postoperative day (POD) 11 (+/− 3 days), their wounds were examined. When an SSI was diagnosed, a wound swab was collected and sent to the Rwandan National Reference Laboratory for culturing and antibiotic susceptibility testing. Findings: Nine hundred thirty women were enrolled, of whom 795 (85.5%) returned for the POD 11 clinic visit. 45 (5.7%) of the 795 were diagnosed with SSI and swabs were collected from 44 of these 45 women. From these 44 swabs, 57 potential pathogens were isolated. The most prevalent bacteria were coagulase-negative staphylococci (n = 12/57, 20.3% of all isolates), and Acinetobacter baumannii complex (n = 9/57, 15.2%). 68.4% (n = 39) of isolates were gram negative; 86.7% if excluding coagulase-negative staphylococci. No gram-negative pathogens isolated were susceptible to ampicillin, and the vast majority demonstrated intermediate susceptibility or resistance to ceftriaxone (92.1%) and cefepime (84.6%). Conclusions: Bacterial isolates from SSI swab cultures in rural Rwanda predominantly consisted of gram-negative pathogens and were largely resistant to commonly used antibiotics. This raises concerns about the effectiveness of antibiotics currently used for surgical prophylaxis and treatment and may guide the appropriate selection of treatment of SSIs in rural Rwanda and comparable settings.https://annalsofglobalhealth.org/articles/3413 |
| spellingShingle | Lotta Velin Grace Umutesi Robert Riviello Moses Muwanguzi Lisa M. Bebell Marthe Yankurije Kara Faktor Theoneste Nkurunziza Gilbert Rukundo Jean de Dieu Gatete Ivan Emil Bethany L. Hedt-Gauthier Fredrick Kateera Surgical Site Infections and Antimicrobial Resistance After Cesarean Section Delivery in Rural Rwanda Annals of Global Health |
| title | Surgical Site Infections and Antimicrobial Resistance After Cesarean Section Delivery in Rural Rwanda |
| title_full | Surgical Site Infections and Antimicrobial Resistance After Cesarean Section Delivery in Rural Rwanda |
| title_fullStr | Surgical Site Infections and Antimicrobial Resistance After Cesarean Section Delivery in Rural Rwanda |
| title_full_unstemmed | Surgical Site Infections and Antimicrobial Resistance After Cesarean Section Delivery in Rural Rwanda |
| title_short | Surgical Site Infections and Antimicrobial Resistance After Cesarean Section Delivery in Rural Rwanda |
| title_sort | surgical site infections and antimicrobial resistance after cesarean section delivery in rural rwanda |
| url | https://annalsofglobalhealth.org/articles/3413 |
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