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Kpagoi SSTK, Kamara KN, Carshon-Marsh R, Delamou A, Manzi M, Kamara RZ, Moiwo MM, Kamara M, Koroma Z, Lakoh S, Fofanah BD, Kamara IF, Kanu ABJ, Kenneh S, Kanu JS, Margao S, Kamau EM. Assessing Changes in Surgical Site Infections and Antibiotic Use among Caesarean Section and Herniorrhaphy Patients at a Regional Hospital in Sierra Leone Following Operational Research in 2021. Trop Med Infect Dis 2023; 8:385. [PMID: 37624323 PMCID: PMC10458420 DOI: 10.3390/tropicalmed8080385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Surgical site infections (SSIs) are a major public health threat to the success of surgery. This study assessed changes in SSIs and use of antibiotics among caesarean section (CS) and herniorrhaphy patients at a regional hospital in Sierra Leone following operational research. This was a comparative before and after study using routine hospital data. The study included all the CS and herniorrhaphy patients who underwent surgery between two time periods. Of the seven recommendations made in the first study, only one concerning improving the hospital's records and information system was fully implemented. Three were partially implemented and three were not implemented. The study population in both studies showed similar socio-demographic characteristics. The use of postoperative antibiotics for herniorrhaphy in both studies remained the same, although a significant increase was found for both pre- and postoperative antibiotic use in the CS patients, 589/596 (98.8%) in 2023 and 417/599 (69.6%) in 2021 (p < 0.001). However, a significant decrease was observed in the overall incidence of SSIs, 22/777 (2.8%) in 2023 and 46/681 (6.7%) in 2021 (p < 0.001), and the incidence of SSIs among the CS patients, 15/596 (2.5%) in 2023 and 45/599 (7.5%) in 2021 (p < 0.001). The second study highlights the potential value of timely assessment of the implementation of recommendations following operational research.
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Affiliation(s)
- Satta Sylvia Theresa Kumba Kpagoi
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
- Department of Nursing, School of Community Health Sciences, Bo Campus, Njala University, Bo 00232, Sierra Leone
| | - Kadijatu Nabie Kamara
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
| | - Ronald Carshon-Marsh
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Alexandre Delamou
- Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry 00224, Guinea;
| | | | - Rugiatu Z. Kamara
- United States Centers for Disease Control and Prevention, Public Health Emergency Operations Center, Freetown 00232, Sierra Leone;
| | - Matilda Mattu Moiwo
- Ministry of Defense, Republic of Sierra Leone Armed Forces, Freetown 00232, Sierra Leone;
| | - Matilda Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
| | - Zikan Koroma
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
| | - Bobson Derrick Fofanah
- World Health Organization Country Office, 21A-B Riverside Drive, Freetown 00232, Sierra Leone; (B.D.F.); (I.F.K.)
| | - Ibrahim Franklyn Kamara
- World Health Organization Country Office, 21A-B Riverside Drive, Freetown 00232, Sierra Leone; (B.D.F.); (I.F.K.)
| | - Alex Bumble John Kanu
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
| | - Sartie Kenneh
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
| | - Joseph Sam Kanu
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
| | - Senesie Margao
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
| | - Edward Mberu Kamau
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) at the World Health Organization (WHO), 1211 Geneva, Switzerland;
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Carshon-Marsh R, Squire JS, Kamara KN, Sargsyan A, Delamou A, Camara BS, Manzi M, Guth JA, Khogali MA, Reid A, Kenneh S. Incidence of Surgical Site Infection and Use of Antibiotics among Patients Who Underwent Caesarean Section and Herniorrhaphy at a Regional Referral Hospital, Sierra Leone. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4048. [PMID: 35409731 PMCID: PMC8998544 DOI: 10.3390/ijerph19074048] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 12/22/2022]
Abstract
Surgical site infections (SSIs) are common postoperative complications. Surgical antibiotic prophylaxis (SAP) can prevent the occurrence of SSIs if administered appropriately. We carried out a retrospective cohort study to determine the incidence of SSIs and assess whether SAP were administered according to WHO guidelines for Caesarean section (CS) and herniorrhaphy patients in Bo regional government hospital from November 2019 to October 2020. The analysis included 681 patients (599 CSs and 82 herniorrhaphies). Overall, the SSI rate was 6.7% among all patients, and 7.5% and 1.2% among CS patients and herniorrhaphy patients, respectively. SAP was administered preoperatively in 85% of CS and 70% of herniorrhaphy patients. Postoperative antibiotics were prescribed to 85% of CS and 100% of herniorrhaphy patients. Ampicillin, metronidazole, and amoxicillin were the most commonly used antibiotics. The relatively low rate of SSIs observed in this study is probably due to improved infection prevention and control (IPC) measures following the Ebola outbreak and the current COVID-19 pandemic. A good compliance rate with WHO guidelines for preoperative SAP was observed. However, there was a high use of postoperative antibiotics, which is not in line with WHO guidelines. Recommendations were made to ensure the appropriate administration of SAP and reduce unnecessary use of antibiotics.
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Affiliation(s)
- Ronald Carshon-Marsh
- District Health Management Team, Ministry of Health and Sanitation (MOHS), Bo District, Bo City 00232, Sierra Leone
| | - James Sylvester Squire
- National Disease Surveillance Programme, Directorate of Health Security and Emergencies, MOHS, Cockerill, Wilkinson Road, Freetown 00232, Sierra Leone
| | - Kadijatu Nabbie Kamara
- National Disease Surveillance Programme, Directorate of Health Security and Emergencies, MOHS, Cockerill, Wilkinson Road, Freetown 00232, Sierra Leone
| | | | - Alexandre Delamou
- Department of Public Health, Gamal University of Conakry, Conakry BP 1147, Guinea
| | - Bienvenu Salim Camara
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Maferinyah National Center for Training and Research in Rural Health, Forécariah BP 2649, Guinea
| | | | - Jamie Ann Guth
- Global Health Connections, Center Barnstead, Barnstead, NH 03225, USA
| | - Mohamed Ahmed Khogali
- Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organisation, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Anthony Reid
- Operational Research Unit Luxembourg, Medecins Sans Frontieres/Doctors without Borders, 68 Rue Gasperich, L-1617 Luxembourg, Luxembourg
| | - Sartie Kenneh
- Office of the Chief Medical Officer, Ministry of Health and Sanitation, 4th Floor, Youyi Building, Brookfields, Freetown 00232, Sierra Leone
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Wounds, Antimicrobial Resistance and Challenges of Implementing a Surveillance System in Myanmar: A Mixed-Methods Study. Trop Med Infect Dis 2021; 6:tropicalmed6020080. [PMID: 34070228 PMCID: PMC8163183 DOI: 10.3390/tropicalmed6020080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/29/2022] Open
Abstract
Wound infections with drug-resistant bacteria lead to higher mortality and morbidity and increased healthcare costs. We aimed to describe the spectrum of bacterial pathogens, isolated from wound cultures in Yangon General Hospital in 2018, and their antimicrobial resistance (AMR) patterns and to understand the challenges in implementing an AMR surveillance system in Myanmar. We conducted a concurrent mixed-methods study involving analysis of surveillance data and in-depth interviews with nine key personnel involved in AMR surveillance. Of 1418 wound specimens processed, 822 (58%) were culture-positive. The most common Gram-positive bacteria were coagulase-negative staphylococci (23.3%) and Staphylococcus aureus (15.1%). Among Gram-negative bacteria, Escherichia coli (12.5%) and Pseudomonas aeruginosa (10.1%) were common. Staphylococcus aureus isolates were resistant to penicillin (98%), oxacillin (70%) and tetracycline (66%). Escherichia coli showed resistance to ampicillin (98%). Lack of dedicated and trained staff (microbiologist, technician, data entry operator), lack of computers at sentinel sites and non-uniform and non-standardized data capture formats were the major challenges in implementing AMR surveillance. These challenges need to be addressed urgently. We also recommend periodic analysis and sharing of antibiograms at every hospital to inform the treatment regimens used in wound management.
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Cabral BG, Brasiliense DM, Furlaneto IP, Rodrigues YC, Lima KVB. Surgical Site Infection Following Caesarean Section by Acinetobacter Species: A Report from a Hyperendemic Setting in the Brazilian Amazon Region. Microorganisms 2021; 9:microorganisms9040743. [PMID: 33918140 PMCID: PMC8067217 DOI: 10.3390/microorganisms9040743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 12/31/2022] Open
Abstract
Surgical site infection (SSI) following caesarean section is associated with increased morbidity, mortality, and significant health care costs. This study evaluated the epidemiological, clinical, and microbiological features of Acinetobacter spp. in women with SSIs who have undergone caesarean section at a referral hospital in the Brazilian Amazon region. This study included 69 women with post-caesarean SSI by Acinetobacter spp. admitted to the hospital between January 2012 and May 2015. The 69 Acinetobacter isolates were subjected to molecular species identification, antimicrobial susceptibility testing, detection of carbapenemase-encoding genes, and genotyping. The main complications of post-caesarean SSI by Acinetobacter were inadequate and prolonged antibiotic therapy, sepsis, prolonged hospitalization, and re-suture procedures. A. baumannii, A. nosocomialis and A. colistiniresistens species were identified among the isolates. Carbapenem resistance was associated with OXA-23-producing A. baumannii isolates and IMP-1-producing A. nosocomialis isolate. Patients with multidrug-resistant A. baumannii infection showed worse clinical courses. Dissemination of persistent epidemic clones was observed, and the main clonal complexes (CC) for A. baumannii were CC231 and CC236 (Oxford scheme) and CC1 and CC15 (Pasteur scheme). This is the first report of a long-term Acinetobacter spp. outbreak in women who underwent caesarean section at a Brazilian hospital. This study demonstrates the impact of multidrug resistance on the clinical course of post-caesarean infections.
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Affiliation(s)
- Blenda Gonçalves Cabral
- Parasitic Biology in the Amazon Region, Center of Biological and Health Sciences, State University of Pará, Belém 66087-662, PA, Brazil; (B.G.C.); (Y.C.R.); (K.V.B.L.)
| | - Danielle Murici Brasiliense
- Bacteriology and Mycology Section, Evandro Chagas Institute, Ananindeua 67030-000, PA, Brazil
- Correspondence: ; Tel.: +55-9132-1421-16
| | | | - Yan Corrêa Rodrigues
- Parasitic Biology in the Amazon Region, Center of Biological and Health Sciences, State University of Pará, Belém 66087-662, PA, Brazil; (B.G.C.); (Y.C.R.); (K.V.B.L.)
| | - Karla Valéria Batista Lima
- Parasitic Biology in the Amazon Region, Center of Biological and Health Sciences, State University of Pará, Belém 66087-662, PA, Brazil; (B.G.C.); (Y.C.R.); (K.V.B.L.)
- Bacteriology and Mycology Section, Evandro Chagas Institute, Ananindeua 67030-000, PA, Brazil
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