School of Medicine and Oral Health, Department of Pathology, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre, Malawi.
Bwaila Hospital, P.O. Box 1274, Lilongwe, Malawi.
Antimicrob Resist Infect Control. 2024 Oct 29;13(1):131. doi: 10.1186/s13756-024-01483-5.
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).
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.
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 (χ = 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.
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.
手术部位感染（SSI）是最常见的与医疗保健相关的感染之一，也是手术可预防的并发症；继续对患者和医疗保健人员的健康和财务资源造成重大影响，从而威胁公共健康。因此，本研究旨在确定 QECH 行剖宫产（CS）术后患者 SSI 的发生率、危险因素和与 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设计，涉及 2023 年 2 月至 2023 年 7 月期间在 QECH 行 CS 的孕妇，术后 30 天进行随访。从所有感染性 CS 伤口采集伤口标本（伤口拭子），并在 QECH 主实验室进行处理，采用 Kirby-Bauer 圆盘扩散法进行药敏试验，结果仅报告敏感、中介或耐药，收集的数据使用 Stata 进行分析。
在研究期间，QECH 记录的 SSI 总累积发生率为 9.61%（208 例中 20 例）。其中，19 例（95%）报告 CS 后出现浅表 SSI。平均年龄为 26.1 岁，标准差为 6.2。所有行 CS 的孕妇均接受了抗生素预防。本研究显示，138 例（66.35%）患者在不知道分离出的特定细菌的情况下，同时接受了术前抗生素（头孢曲松）和 CS 后抗生素治疗。本研究表明，胎膜破裂的 SSI 发生率是胎膜完整的两倍（χ=2.0922），但无统计学意义。大多数 SSI 患者（n=12，60%）需要再次入院，20 例 SSI 患者中有 5 例（25%）对药敏试验结果显示具有抗菌药物耐药性。金黄色葡萄球菌是最常见的病原体（3 例，60%），其他细菌分离株包括肠杆菌科和鲍曼不动杆菌。
QECH 行 CS 术后 SSI 的发生率和抗菌药物的不适当使用仍然是一个挑战。因此，由于 CS 后 SSI 数量增加，以及 AMR 的相对出现，需要加强感染预防和控制措施，在 QECH 建立抗菌药物管理计划和对 SSI 的常规监测。
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