Surgical site infection and antimicrobial use following caesarean section at QECH in Blantyre, Malawi: a prospective cohort study.

IF 4.8 2区 医学 Q1 INFECTIOUS DISEASES
Amos Tumizani Kachipedzu, David King Kulapani, Samuel James Meja, Janelisa Musaya
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Abstract

Background: Surgical site infections (SSIs) are one of the most common healthcare-associated infections and preventable complication of surgical procedure; continue to threaten public health with significant effects on the patients and health care human and financial resources. Therefore, this study aimed to determine the incidence of SSIs, risk factors and common microorganisms associated with SSI and assess the practice of antimicrobial use in women following Caesarean Section (CS) at Queen Elizabeth Central Hospital (QECH).

Methods: This was a hospital-based quantitative prospective study design involving pregnant women who underwent a CS between February, 2023 and July, 2023 at QECH with 30 day-follow-ups. Wound specimens (wound swabs) were collected from all infected CS wounds and processed at QECH main laboratory, and susceptibility testing was conducted using the Kirby-Bauer disk diffusion method with results reported only as susceptible, intermediate, or resistant and the collected data was analyzed using Stata.

Results: The overall cumulative incidence of SSI recorded at QECH during the study period was 9.61% (20 cases out of 208). Of these, 19 (95%) of them reported superficial SSI following CS. The mean age was 26.1 years with a standard deviation of 6.2. All pregnant women who underwent for CS received antibiotic prophylaxis. This study revealed that 138 (66.35%) patients received both preoperative antibiotics (ceftriaxone) and post-CS antibiotics without knowing the specific bacterial organism isolated. This study revealed that ruptured membrane had twice the incidence of SSIs compared to intact membrane (χ2 = 2.0922), though not statistically significant. The majority of patients with SSIs (n = 12, 60%) were readmitted and 5 (25%) out of 20 with SSIs had antimicrobial resistance following susceptibility testing. Staphylococcus aureus was the most common organism (3, 60%) and other bacterial isolates included were Enterobacteriaceae and Acinetobacter baumanni.

Conclusion: The incidence of SSIs and inappropriate antimicrobial use following CS remains a challenge at QECH. Therefore, due to increased number of SSIs following CS with relative emergence of AMR ensure intensive infection prevention and control practices, establishing AMS program and routine surveillance of SSIs at QECH.

马拉维布兰太尔 QECH 医院剖腹产手术后的手术部位感染和抗菌药物使用情况:一项前瞻性队列研究。
背景:手术部位感染(SSI)是最常见的医疗相关感染之一,也是手术过程中可预防的并发症;它继续威胁着公众健康,对患者和医疗保健的人力和财力资源造成重大影响。因此,本研究旨在确定伊丽莎白女王中央医院(QECH)剖腹产(CS)术后妇女的 SSI 发生率、风险因素和与 SSI 相关的常见微生物,并评估抗菌药物的使用情况:这是一项基于医院的定量前瞻性研究,涉及2023年2月至2023年7月期间在伊丽莎白女王中央医院接受剖腹产手术的孕妇,并进行30天随访。从所有感染的CS伤口采集伤口标本(伤口拭子),并在QECH主实验室进行处理,使用Kirby-Bauer盘扩散法进行药敏试验,结果仅报告为易感、中度或耐药,并使用Stata对收集的数据进行分析:研究期间,青海省儿童医院记录的 SSI 总累计发病率为 9.61%(208 例中有 20 例)。其中,19 例(95%)报告了 CS 后的表皮 SSI。平均年龄为 26.1 岁,标准差为 6.2 岁。所有接受 CS 的孕妇都接受了抗生素预防治疗。本研究显示,138 例(66.35%)患者术前服用了头孢曲松(ceftriaxone),术后服用了抗生素,但并不知道分离出的具体细菌是什么。该研究显示,与完整膜相比,破裂膜的 SSI 发生率是完整膜的两倍(χ2 = 2.0922),但无统计学意义。大多数 SSI 患者(12 人,60%)再次入院,20 名 SSI 患者中有 5 人(25%)在药敏试验后对抗菌素产生耐药性。金黄色葡萄球菌是最常见的病原体(3 例,占 60%),其他细菌分离物包括肠杆菌科和鲍曼不动杆菌:结论:在青科医院,CS后SSI的发生率和抗菌药物的不当使用仍是一项挑战。因此,鉴于 CS 后 SSI 的增加以及 AMR 的相对出现,QECH 应加强感染预防和控制措施,制定 AMS 计划并对 SSI 进行常规监测。
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来源期刊
Antimicrobial Resistance and Infection Control
Antimicrobial Resistance and Infection Control PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES
CiteScore
9.70
自引率
3.60%
发文量
140
审稿时长
13 weeks
期刊介绍: Antimicrobial Resistance and Infection Control is a global forum for all those working on the prevention, diagnostic and treatment of health-care associated infections and antimicrobial resistance development in all health-care settings. The journal covers a broad spectrum of preeminent practices and best available data to the top interventional and translational research, and innovative developments in the field of infection control.
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