Surveillance of surgical site infections by and strain characterization in Tanzanian hospitals does not provide proof for a role of hospital water plumbing systems in transmission.

BACKGROUND

The role of hospital water systems in the development of () surgical site infections (SSIs) in low-income countries is barely studied. This study characterized isolates from patients and water in order to establish possible epidemiological links.

METHODS

Between December 2014 and September 2015, rectal and wound swabs, and water samples were collected in the frame of active surveillance for SSIs in the two Tanzanian hospitals. Typing of was done by multi-locus sequence typing.

RESULTS

Of 930 enrolled patients, 536 were followed up, of whom 78 (14.6%, 95% CI; 11.6-17.5) developed SSIs. was found in eight (14%) of 57 investigated wounds Of the 43 water sampling points, 29 were positive for . However, epidemiological links to wound infections were not confirmed. The carriage rate on admission was 0.9% (8/930). Of the 363 patients re-screened upon discharge, four (1.1%) possibly acquired during hospitalization. Wound infections of the three of the eight SSIs were caused by a strain of the same sequence type (ST) as the one from intestinal carriage. Isolates from patients were more resistant to antibiotics than water isolates.

CONCLUSIONS

The SSI rate was low. There was no evidence for transmission from tap water. Not all SSI were proven to be endogenous, pointing to other routes of transmission.