Antimicrobial susceptibility and risk factors associated with bacterial post-operative surgical site infections in obstetrics and gynaecology patients at Naggalama Hospital, Uganda

Abstract

Background: Surgical site infection (SSI) is one of the nosocomial infections that threatens health systems. The aim of this research was to determine antimicrobial susceptibility, biosafety considerations and risk factors associated with bacterial post-operative SSI in obstetrics and gynaecology patients. Despite the efforts put in place to minimize incidence of surgical site infections through sterilization of equipment, disinfection of theater surfaces, aseptic surgical techniques, antimicrobial prophylaxis; post-operative surgical site infections still and is continuing to cause burden in health care units evidenced by increased cases of mortality, costs of treatment and length of hospital stays. These may be due to several risk factors associated with post-operative surgical site infection and on the other hand, the existence of additional measures such as the availability of personal protective equipment and training among healthcare staff are factors that can contribute for reducing risk factors of contamination and spread of pathogens. Some of isolated bacteria are resistant to antibiotics including multi-drug resistant (MDR) strains which can be a burden globally. Methodology: A cross-sectional study was conducted at Naggalama hospital over a four-month period. The study involved mothers that were admitted and underwent obstetric and/or gynecological operation at Naggalama hospital. Results: One hundred twenty-four (124) women were enrolled in the study, majority in age group of 17-25 years. 98.4% of patients underwent obstetrics procedures with only 1.6% gynecological procedures. 96.8% were caesarean section and 96.1% of patients had emergency procedures. Mean estimated blood loss during operation was 335.7±130.2 ml. Prevalence of SSI was 20.97% and risk factors associated with surgical site infection were; level of education, P value = 0.017 (AOR 0.064, 95%CI 0.007-0.61), availability of medicines from the hospital pharmacy, P value = 0.017 (AOR 9.851, 95% CI 1.5-64.69). Referral patients, P value = 0.011 (AOR 0.115, 95% CI 0.022-0.61). Increase in the amount of blood loss during operation, p value = 0.011 (AOR 1.009, 95% CI 1.002-1.016). Increase in the number of baths per day, p value = 0.024 (AOR 0.152, 95% CI 0.029-0.783). The commonest isolated bacteria were S. aureus (33.3%) followed by K. pneumonia (20%) and E. coli (16.7%). Resistance to, Oxacillin and Tetracycline among Enterobacteriaceae. E. coli showed 80% resistance Ceftazidime-clavulanic as most K. Pneumoniae were susceptible (80%). Except Ciprofloxacin for E. coli, K. pneumoniae and E. coli were susceptible to Imipenem, Ciprofloxacin, Chloramphenicol and Gentamycin. S. aureus showed susceptibility to Imipenem, Vancomycin, Ceftazidime-Clavulanic acid, Tetracycline and Chloramphenicol. Most bacteria were multi drug resistant. Ampicillin was completely ineffective against all bacteria isolated. Antibacterial options for SSI are; Gentamycin, Ciprofloxacin, imipenem, chloramphenicol, Ceftazidime-clavulanic acid, Vancomycin, Chloramphenicol and Tetracycline. In addition, the biosafety considerations are required to protect the healthcare workers and the patients from exposure to infectious agents. Biosafety procedures such as putting on personal protective equipment, disinfection of surgical materials, ensuring aseptic surgical procedure were observed by medical practitioners and use to standard operating procedures. In some wards, patients with septic cases were isolated in the “septic room” to separate them from those without sepsis but in other wards it wasn’t observed. Recommendations: Due to high burden of SSI, it greatly threatens maternal child health, this calls for improvement of appropriate infection prevention and control measures and need for regular training on biosafety procedures. More studies are required to explore the level of bacterial contamination of theater and ward fomites as well as level of bacterial contamination of air in the operating theaters. At laboratory level, the government and hospital administration should enforce and regularly monitor the storage and/or disposal of bio materials such as bacterial cultures since some contains potentially drug resistant bacterial strain that can pose serious biological threat to the environment and the population. Further studies are also required to explore into the biosafety and biosecurity status in clinical settings. Patients should be offered appropriate advice on how to maintain personal hygiene and they should be made aware of the relevance of adhering to recommended medications with emphasis on timeliness of antibiotic therapy post-operation and completion of dose.