Surgical Site Infections and Antimicrobial Resistance After Cesarean Section Delivery in Rural Rwanda.
Surgical Site Infections and Antimicrobial Resistance After Cesarean Section Delivery in Rural Rwanda.
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DOI：
10.5334/aogh.3413
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发表时间：
2021
影响因子：
2.9
通讯作者：
Kateera F
中科院分区：
文献类型：
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作者：
Velin L;Umutesi G;Riviello R;Muwanguzi M;Bebell LM;Yankurije M;Faktor K;Nkurunziza T;Rukundo G;de Dieu Gatete J;Emil I;Hedt-Gauthier BL;Kateera F
随着低收入和中等收入国家（LMIC）手术病例数量的增加，尽管缺乏关于耐药性模式的数据，但由于抗菌素耐药性（AMR）的轶事证据，手术部位感染（SSI）变得更加普遍。作为主要目标，这项前瞻性研究旨在描述卢旺达乡村医院剖腹产妇女中SSI的流行病学以及相关的AMR。作为次要目的，本研究还评估了患者人口统计学、术前和术后抗生素使用以及SSI治疗。前瞻性招募了2019年9月23日至2020年3月16日期间在Kirehe地区医院接受剖宫产的女性。在术后第11天（+/- 3天），检查其伤口。当诊断出SSI时，收集伤口拭子并送往卢旺达国家参考实验室进行培养和抗生素敏感性测试。入组了930名女性，其中795名（85.5%）返回接受POD 11诊所访视。795名妇女中有45名（5.7%）被诊断为SSI，从这45名妇女中的44名收集了拭子。从这44份拭子中分离出57种潜在病原体。最常见的细菌是凝固酶阴性葡萄球菌（n = 12/57，占所有分离株的20.3%）和鲍曼不动杆菌复合菌（n = 9/57，15.2%）。68.4%（n = 39）的分离株为革兰氏阴性;如果排除凝固酶阴性葡萄球菌，则为86.7%。革兰阴性菌对氨苄西林无敏感性，绝大多数对头孢曲松（92.1%）和头孢吡肟（84.6%）中度敏感或耐药。卢旺达农村SSI拭子培养物中的细菌分离株主要由革兰氏阴性病原体组成，并且对常用抗生素具有很大的耐药性。这引起了人们对目前用于手术预防和治疗的抗生素有效性的关注，并可能指导卢旺达农村和类似环境中SSI治疗的适当选择。
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. 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. 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. 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%). 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.