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...

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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	Ubiquity Press 2021
Materias:	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/114b2c84fe8b48b3851992b38d48c11d
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spelling	oai:doaj.org-article:114b2c84fe8b48b3851992b38d48c11d2021-12-02T19:13:58ZSurgical Site Infections and Antimicrobial Resistance After Cesarean Section Delivery in Rural Rwanda2214-999610.5334/aogh.3413https://doaj.org/article/114b2c84fe8b48b3851992b38d48c11d2021-08-01T00:00:00Zhttps://annalsofglobalhealth.org/articles/3413https://doaj.org/toc/2214-9996Background: 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.Lotta VelinGrace UmutesiRobert RivielloMoses MuwanguziLisa M. BebellMarthe YankurijeKara FaktorTheoneste NkurunzizaGilbert RukundoJean de Dieu GateteIvan EmilBethany L. Hedt-GauthierFredrick KateeraUbiquity PressarticleInfectious and parasitic diseasesRC109-216Public aspects of medicineRA1-1270ENAnnals of Global Health, Vol 87, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
spellingShingle	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270 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
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.
format	article
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
title	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_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_sort	surgical site infections and antimicrobial resistance after cesarean section delivery in rural rwanda
publisher	Ubiquity Press
publishDate	2021
url	https://doaj.org/article/114b2c84fe8b48b3851992b38d48c11d
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Surgical Site Infections and Antimicrobial Resistance After Cesarean Section Delivery in Rural Rwanda

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